How it works

Let’s break it up: Asynchronous means not existing or happening at the same time. Teledermatology is the practice of dermatology via virtual means, usually using photos to transmit your problem to the doctor or other provider. What this means is you take a few pictures and answer a few questions about your skin problem when it’s convenient for you, and a provider gets back to you as soon as possible with an assessment and treatment plan. No waiting weeks or months for an appointment, taking off time from work, and driving and waiting in a busy doctor’s office.

Many skin issues can be diagnosed and treated via online dermatology consultations including acne, rosacea, psoriasis, eczema, and other rashes (the presence of numerous spots, bumps, patches, blisters or other lesions on your skin, either in a localized area or all over). We can even sometimes detect and diagnose skin cancers. The limitations of virtual care like asynchronous teledermatology are still being explored, and its equivalency to in-person care has not been established or proven, but we think with high-quality photographs almost all skin conditions can begin to be managed with teledermatology. However, for severe or complex cases, an in-person visit may be required. Of course, you are always welcome to submit images and we will fully disclose what limitations may prevent us from adequately addressing your concerns.

Miiskin is a teledermatology app that was created to make healthcare better for both the patient and the provider. We have chosen to use Miiskin because they have superior skin imaging capabilities for accurate diagnosis and treatment. It also helps you track treatment progress, allows you to communicate with your provider, make adjustments, and request medication renewals. All your data including any images are securely stored within the app and only accessible to you and your healthcare provider.

Typically, faster than it would take if you started the process by scheduling an in-person appointment with a dermatology provider. Once you have obtained photographs and answered questions about your skin condition, the information will be transmitted to an expert who will review your case, usually within 1-2 working days. However, many times you will hear back from us even sooner. For urgent issues or symptoms, we aim to get you help within hours (we DO NOT address medical emergencies). It's uncommon for it to take more than 3 working days. Our goal is to get you answers as quickly as possible. Although we can't guarantee turnaround time (yet), we will be as transparent as possible with our wait times.

We will not compromise quality. Bridge Dermatology’s mission is to provide care that is equivalent to an in-person visit, and we believe with time and the evolution of our service, we will be able to do that and even exceed in-person care. If for any reason we don’t think we can provide you with excellent care virtually, we will work with you to find a local healthcare provider who can see you in person.

Because our service is done asynchronously, you see the doctor when it is most convenient for you. No more missing days of work or school for an in-person visit only to find out you or your doctor needs to reschedule because of unforeseen circumstances. No more paying for parking, or waiting for long delays in the doctor's office. And, no more waiting anxiously to find out your problem is much more minor than you expected, or waiting uncomfortably because your skin is driving you crazy.

Let’s be honest: there is a lot of pressure to address all of your concerns in the allotted appointment time. Going to the doctor can often feel rushed and overwhelming, even for the healthcare provider! This allows you and the healthcare provider to take as much time as necessary to express your concerns and make sure they are answered. If you are unsure of a medication you previously used, you can take the time to find out what it was without missing valuable time with the healthcare provider. If your provider is unsure about a diagnosis, he or she can seek out the resources necessary to get you the guidance you deserve.

In the opinion of Bridge Dermatology, it’s better because it’s not in lieu of in-person care, it’s in addition to in-person care. You aren’t giving up your ability to be seen in-person with Bridge Dermatology. In fact, if it’s determined you need to be seen in-person we can help arrange that in a timely fashion, potentially sooner than if you had sought out in-person care on your own. Asynchronous technology also allows us to sort out the most urgent cases so that you get the help you need as quickly as possible. Additionally, by being primarily virtual-based, we can leverage technology to stay connected and help monitor your skin without you needing to return to the office. You have access to us beyond the typical face-to-face time you would spend with your doctor, saving you time, money, and repeated trips to the doctor.

In nearly all circumstances, no. Not only are we not allowed to bill your insurance twice, we are not in the business of trying to extract as much money from you as possible. We want you to see immense value in the care you get through Bridge Dermatology. If it's determined you need to see a healthcare provider in person, you will not be charged another evaluation fee. Only Bridge Dermatology or the in-person provider will charge an evaluation fee, not both. In some circumstances, you may get charged an evaluation fee through Bridge Dermatology and a fee for a procedure by an in-person provider that is related to that evaluation, but you will never pay twice for the evaluation. For self-pay patients, there are some scenarios where you could be charged two evaluation fees. One example of this is if we identify an urgent problem that we can help you with, even potentially prescribed medications for, but still feel that follow up or in-person evaluation is also important. However, our self-pay prices are incredibly competitive and we think you will see that the value and guidance you will get, even if it is deemed you need to see a provider in person, is well-worth the price-point.

We currently do not offer video consultations. We believe the quality that can be obtained via video is not adequate to assess skin conditions. Still photographs provide much better resolution and detail, and allow for better documentation (can be stored for later comparison - videos are not recorded).

Many times, the provider caring for you will send messages to clarify details of your condition, so there will may be some component of back in forth communication with your provider that already will occur in real time. Additionally, some patients and conditions may benefit from a phone discussion as a component of the visit. Begin the consultation via the asynchronous method and indicate and if you or the provider decide a phone call would be of benefit, that can be arranged. This may delay part of your care, but is always available to the patients we serve.

The consultation payment covers a photo consultation where an assessment and treatment plan will be created for you along with the prescription of any medications or labs that you may have requested or the provider deemed medically necessary and appropriate. Unless otherwise specified, the cost of recommended medications or labs is NOT included in the consultation payment, but you are never obligated to pay for medications or get labs that are recommended if you chose not to follow those recommendations. Also, even though your insurance may not cover your consultation fee, they may cover the medications or labs that are recommended as a result. Two weeks of follow-up is included in the consultation, meaning you can ask anything about the problem or its treatments in that timeframe. In the future, we may offer consultation packages that will include longer periods of unlimited follow-up, for example, periods of 3, 6, or even 12 months may be included.

We always prescribe generic medications when available or appropriate, but in the current healthcare environment that does not always guarantee they will be affordable. Branded medications are also available if this is what you prefer. If a specific medication brand is prescribed (such as Seysara, Winlevi or Altreno), then please see this guide for different options to get discounted prices on these otherwise costly brand medications. We also can prescribe compounded formulas available through mail order from Skin Medicinals, a reputable online pharmacy that specializes in dermatology medications. If you opt-in to receive a compounded medication, additional non-compounded medications (if necessary) will be sent to your preferred pharmacy. Compounded medications are not covered by insurance. Other applications like GoodRx or SingleCare offer solutions to obtain medications at the cheaper prices.

We are not a compounding pharmacy and don't make money off of selling you prescriptions. This is one of the advantages to Bridge Dermatology. We are not in the business of trying to sell you a product, but to provide you with the best possible skin care recommendations and options. As a result, we do not compound medications. We can prescribe some compounded medications through Skin Medicinals, and are happy to send any prescription you would like, if deemed medically appropriate, to a compounding pharmacy of your choice.

We cannot guarantee any specific prescription or that a prescription will be sent, but we can guarantee that we will work closely with you to offer the best dermatology care. This often includes prescription medications, and if safe and appropriate for your condition they will be prescribed. However, it’s essential to note that certain health conditions or pregnancy can influence the recommended treatment plan.

Most medications can be picked up at your preferred pharmacy like CVS, Walgreens, or any other brick-and-mortar pharmacy you choose. Some compounded medications or specialized medications may be ordered through compounding pharmacies like Skin Medicinals, or other mail-order pharmacies that provide specialty medications. If you are using insurance, we can send medications to any pharmacy your insurance prefers, provided they carry those medications.

One consultation is normally required for the provider to decide upon a treatment plan and a prescription. Normally, a 2 week period is allowed for follow up questions related to that problem at no charge. For simple problems, no further follow up is required. For more serious conditions, an additional follow-up appointment (and associated charge) may be required 1-3 months after your initial consultation. Some chronic conditions like psoriasis require a visit every 6-12 months for a status check. Medical problems are not always predictable, however, so the number of virtual visits required to improve, cure, or maintain clearance of your skin condition is difficult to reliably determine. Nevertheless, we will always be as transparent as possible about what you are getting for you consultation fee.

Dr. Trowbridge currently practices dermatology in Omaha, NE and is employed by CHI Health. CHI Health is not affiliated with Bridge Dermatology and does not use Miiskin's platform to facilitate teledermatology. If you want to see Dr. Trowbridge in person please visit CHI Health. CHI Health currently does not offer asynchronous teledermatology.