What About Insurance For Hyperhidrosis?
Most insurance companies cover the procedure because it is seen as a medical necessity. We can help you with any insurance concerns. Our office, as a courtesy, will call your insurance carrier to verify benefits in the event that you choose to have the procedure.
Insurance policies are complicated and very difficult to understand. It is necessary to examine each case on an individual basis. In our office, we have useful information about this process. Those who have questions can fax us the front and back of their insurance cards.
Recently, some insurance companies changed their policies surrounding surgical treatment for hyperhidrosis. In those cases, it is important for the patient to involve themselves in the process. Our office is happy to provide you with the necessary information. Please give us a call at (310) 557-3037.
The Present Situation
U.S. Citizens face a lot of uncertainties about health insurance coverage. Until the dust settles we have to continue with the same approach. This means talking with the insurance companies and trying to convince them to cover the procedure.
This process can be a lengthy one and requires the participation of the patients and their families.
Attempts to get authorization from the insurance companies should start with our office calling the insurance company. At times there is a need for the patient/family to get involved with the process. This is due to the fact that the patient or family are the ones insured and must talk to the insurance company directly. This adds a very personal plea that can sway reluctant insurance companies.
The patients (or their families), who own the insurance policies have a stronger influence. Over the years our attempts to discuss the matter with the medical reviewer are not successful. Many of the reviewers have never seen a patient with this condition. They do not have any appreciation of what these patients are going through.
This makes a personal attempt by the patient more effective. Insurance companies claim that the procedure is not within their coverage, but it is time for that to change. This is especially true when you consider that roughly 1 ½% of the population is affected by hyperhidrosis.
Our office is constantly taking steps to educate the review committees. We discuss the failure of all conservative methods and the validity of surgical treatment. It takes a combined effort by the patient and our office to reach a satisfactory solution.
A Brighter Future
As our experience with these insurance issues evolves, we are starting to see more approvals. Insurance companies are recognizing that both ETS and now the Lumbar Sympathectomy is a valid treatment for hyperhidrosis.
The patient, our office, and their family are assisting throughout the appeal process. We and the patients/families demand an independent outside review. Both our office, and the insurance companies, are committed to following through with whatever decision is made.
It is interesting when these cases are reviewed by totally neutral surgeons. We are starting to use those favorable decisions in cases where we have difficulties with the insurance companies.
The takeaway here is that although it may take time to receive authorization from your insurance company you should never give up. More and more cases are being approved, which shows a positive trend towards a change.
What if I do Not Have Health Insurance, What Should I do?
Patients who do not have health insurance may want to purchase insurance coverage for the operation. As a rule of thumb, health insurance coverage should not be obtained just for this procedure. If one purchases health insurance coverage it should first be followed with conservative attempts to treat hyperhidrosis.
Those attempts should be documented by healthcare professionals. The insurance companies will see a sincere attempt to treat it with alternative methods. To learn more visit our alternative methods to treat hyperhidrosis section.
For those patients who have no health coverage or are from out of the country, we can work with you on payment options. Please contact our office at (310) 557-3037.
What if my Insurance Says they do Not Cover This Procedure?
There is a trend among some large insurance companies to exclude hyperhidrosis treatment from their policies. A similar example of this is the trend to exclude patients from getting surgical treatment for excessive obesity.
In our opinion, if a patient makes the effort to first try conservative measures to help their problem with no success then the surgical option should not be excluded from their policy. If a patient finds out that the surgical hyperhidrosis treatment is excluded from their policy, the patient should challenge their health insurance provider.
Many of our patients have successfully challenged their insurance carriers and received authorization to cover the procedure. Please feel free to contact us for more information (310) 557-3037.
More and more procedures are successfully completed as the information available has become more accessible through the Internet and other information mediums. There has been some reluctance from the insurance companies to cover the cost. As for general information, hyperhidrosis is most likely a genetic disorder and not a cosmetic one.
It is recognized by international health organizations as well as the government. Obviously, the insurance industry is trying to limit the number of these operations from a purely financial perspective.
We are working very hard to educate the insurance industry about this disease. This is a physiological ailment and not just a cosmetic or mental problem. Progress is being made in this regard, especially with the number of medical articles and clinical studies written by Dr. Reisfeld and other surgeons.
It is very important for patients to show any evidence that they first tried some sort of conservative treatment such as Drysol, Drionic, Robinul, etc. If insurance companies require documentation, then the patient will be provided with the appropriate forms.
How We Can Help
In every case, our office will call the insurance company for pre-authorization. Some insurance companies will demand certain steps to be taken beforehand. In these cases, we will tell the patients exactly what is needed and guide them through the process.
Some insurance companies will not respect the pre-authorizations they originally gave out. We will do our best to follow up on such issues. Generally speaking, most of the insurance companies will cover this procedure. HMO’s, in almost all cases, do not cover the procedure.
Since the insurance issue has become so important, we would like to re-emphasize that patients first try some conservative approaches to deal with their excessive sweating. Also, it is very helpful and important to keep documentation that shows such measures were taken.
For those patients who are not covered by any kind of medical insurance, there is an inclusive charge that covers the facility fees, anesthesia fees, and the surgical fees.
For more information feel free to contact our office or call our friendly staff with no obligation and we will be happy to help you.
Phone: (310) 557-3037
Related Insurance Articles:
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- Is the hyperhidrosis surgery right for me??