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Hyperhidrosis Surgery Approval

If the clinical information that is given to the surgeon, either at an office visit or after a telephone consultation is deemed appropriate for surgery then the next step will be to verify the patient’s insurance that is provided to us. Verification includes the ability to perform the surgery by the patient’s insurance company, the amount of co-payment and deductible and also in and out of network benefits. These non medical items are very well handled by our office staff who has the critical experience and patience to navigate this complicated process. Obviously HMO companies pose different challenges to the patient but these issues should be handled by the office staff and the patient or his family.

The process of insurance verification can range between a few weeks to sometimes months. Many factors are involved in this process. If the patient has any medical records from previous treatments it should be made available for our office before we get the approval from the insurance company. That fact that the patient has tried previous treatments with little or no success obviously will help in the process of getting approval. Some insurance companies require patients try conservative measures first before doing the surgery.

Recent years have brought major changes in the insurance industry. Healthcare has become a very convoluted subject that makes the approval process even more difficult. There is no unity the decision / approval process even within the same insurance companies but in different states. Obviously this makes the process longer and more difficult. It seems to us that the insurance companies are slowly trying take the coverage benefits for hyperhidrosis surgery. Even when we conduct peer to peer reviews with the insurance company doctors they agree that those kind of patients with severe cases of hyperhidrosis should receive the procedure after failing the conservative treatments. Unfortunately the reviewing doctors use the statement that the policy of that insurance company is not allowing those kind of treatments.