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 create 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 severe excessive hand sweating. 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.

Dr. Reisfeld agrees with the requirements of the insurance companies that a potential patient should try at least some alternative methods (click here) before they decide to proceed with ETS or Endoscopic Thoractic Sympathectomy for their sweaty hands or Hyperhidrosis. HOWEVER, not all requirements that insurance companies demand show any signs of success and as far as it is known those measures offer only temporary relief.

Of late, insurance companies’ demands that patients try BOTOX® has become more stringent, on top of which they are demanding that patients receive BOTOX® injections for extended periods of time when 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, and the extension of BOTOX® as a treatment over long periods of time is even further unjustified. There are no peer reviewed medical papers that show that BOTOX® helps in Palmar Hyperhidrosis (which is why the FDA has not approved BOTOX® for the treatment of Palmar Hyperhidrosis), and if it does, this is only for a very short period of time. Additionally, it is painful and expensive.

Dr. Reisfeld encourages patients to try the conservative means, but 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 and demand authorization for the procedure.

Pre-existing Condition

As studies have shown, about 50% of the patients have a family history of Hyperhidrosis. This means that the condition is based on hereditary reasons. A patient is born with this quality and to deny the treatment based on this argument is akin to telling a patient with a family history of breast cancer or colon cancer that they can not get treatment due to the fact that they carry the genes for their problem. In Dr. Reisfeld’s records of more than 2500 patients, 51% have a family member who had Hyperhidrosis. Obviously, the severity of the excessive sweating can be different from one generation to the next.

Experimental procedure
Sympathectomy for Palmar Hyperhidrosis is an old and established procedure. It has been conducted for the past 70 years. Obviously several changes and improvements have been made in that time until the present methods were concluded upon. To say that this is an experimental procedure is showing a lack of knowledge in view of the large volume of peer reviewed papers published in many medical and surgical journals. Recently it became known that some insurance companies are using the term “it is not in our policy” to allow 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 if after a peer to peer review which failed to get an authorization it becomes a necessity for the patient to become personally involved with this process which means calling the insurance companies appeal board, supplying them with the appropriate papers (provided by our office), describe their suffering and to try to get a positive response to their requests.
We as providers are limited in our influence over insurance companies whereas as the policy holder (you the patient) much more can accomplished.

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