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Insurance issues and Sympathectomy for Hyperhidrosis.

Hyperhidrosis is a recognized disease by the International Committees on Diseases Nomenclature. It is also recognized by Medicare as a disease entity. As such, patients deserve medical or surgical treatment for Hyperhidrosis.

Unfortunately, insurance companies created new criteria for the treatment of patients who suffer from severe cases of Palmar Hyperhidrosis. A few of their statements are in need of correction since they (the insurance companies) do not have a full understanding of the problems affecting patients who suffer from the condition.

It is strange that private insurance carriers follow Medicare regulations as they see fit. They cut or reduce benefits for patients and doctors alike, but do not follow Medicare decisions when it comes to the treatment of hyperhidrosis. Learn more about ETS/ELS and insurance coverage.

Demand For The Use of Alternative Methods

Dr. Reisfeld agrees with the requirements of the insurance companies that a potential patient should try some alternative methods (click here). They should do this before they decide to proceed with ETS or Endoscopic Thoractic Sympathectomy for their Hyperhidrosis. However, not all requirements that insurance companies demand show any signs of success. Those measures only offer temporary relief.

Of late, insurance companies’ demands that patients try BOTOX® has become more stringent. They are demanding that patients receive BOTOX® injections for extended periods of time. The treatment most often shows a lack of effectiveness very early on.

Although the FDA has approved the use of BOTOX® for axillary sweating or excessive sweating under the arms, it has NOT been approved for the treatment of sweaty palms or feet (Hyperhidrosis).

Therefore, Dr. Reisfeld feels that the demand to try BOTOX® for the treatment of sweaty hands was put in place by insurance companies without any justification. The extension of BOTOX® as a treatment over long periods of time is even further unjustified.

There are no peer-reviewed medical papers which show that BOTOX® helps in Palmar Hyperhidrosis (which is why the FDA has not approved BOTOX® for the treatment of Palmar Hyperhidrosis). If they do, it is only for a very short period of time. Additionally, it is painful and expensive.

Dr. Reisfeld encourages patients to try conservative means of treatment first. If repeated obstacles are encountered in pursuance of the surgical treatment (ETS), it behooves the patient to go directly to the medical director of the insurance company. They should demand authorization for the procedure.

Pre-existing Conditions

Studies show that about 50% of patients have a family history of Hyperhidrosis. This means that the condition is based on hereditary reasons. Insurance companies do not deny coverage for other diseases to patients on the basis of genetic predisposition. Hyperhidrosis should not be any different.

In Dr. Reisfeld’s records of more than 2500 patients, 51% have a family member who had Hyperhidrosis. The severity of the excessive sweating can be different from one generation to the next.

Experimental procedures

The sympathectomy procedure for palmar hyperhidrosis is an old and established procedure. It has been conducted for the past 70 years. It has been altered and improved upon significantly over the years.

It is not an experimental procedure as some would have you believe. There are numerous peer-reviewed papers and thousands of successful cases. Some insurance companies are using the phrase “it is not in our policy” to allow an endoscopic lumbar sympathectomy for excessive foot sweating.

This is another attempt by insurance companies to not provide services for conditions that can be solved with an operation. The main motivation for this is to save money. Attempts to direct their attention to these new procedures are being met with this typical answer.

What we found is that speaking to the company on the patient’s behalf is often not enough to get an authorization. At this point, it becomes a necessity for the patient to become personally involved with this process.

This means calling the insurance company’s appeal board, supplying them with the appropriate papers (provided by our office), describinig the patient’s suffering, and ultimate receive a positive outcome.

We as providers are limited in our influence over insurance companies. The patient has more power to change the decision.

Other topics of interest:

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