When You've Been Denied Coverage

If you find that your health insurance organization will not cover the type of hyperhidrosis treatment your physician recommends, enlist the help of your physician (or his or her staff) to question and appeal the organization’s decision. Remember, hyperhidrosis is a serious medical condition and research has shown that it has a significant negative impact on one's quality of life. With this in mind, ask your insurance company's decision-makers to reconsider.

Here's how:

    • Call your insurance company. There’s usually a toll-free or "800" number you can use. You will most likely end up speaking with a customer service representative. Don’t be afraid to ask for his or her manager.
    • Keep good records. Make a note of the dates and times you speak with customer service representatives. Write down their names and the information they give you. Keep any written correspondences regarding your hyperhidrosis treatment and reimbursement in a file.
    • Become hyper-educated. Visit our Scientific Literature section to read and download studies that have been published in major academic and medical journals. This research informs policy decisions and influences the standard of care.
    • Always include your full name, address, and insurance policy or health plan number on all letters, e-mails, or faxes.
    • Appeal. If you’ve already submitted a request for coverage and have been denied, write another letter appealing the decision. Following an "appeals process" is useful if your request is denied, so ask what this process requires. Appeals can take time but are a good way to get in contact with decision-makers.
    • Talk to your human resources (HR) or benefits manager. If you receive your health insurance coverage through your job, your HR manager may be able to help. Keep your HR department informed and give them copies of all correspondence with the insurance company.
    • Ask someone from your physician’s office to talk (or write) to the insurance company. A healthcare professional with an understanding of your condition and situation can explain why a particular hyperhidrosis treatment is necessary, why excessive sweating is a health concern, and how it may affect other aspects of your health. Facilitate this process by printing our sample Letter of Medical Necessity, Hyperhidrosis Preauthorization Request Form, and, for iontophoresis, Medical Insurance Claim Statement Form for the purchase of a home-use iontophoresis machine. Give these documents to your physician to fill out and submit.
    • Follow up. Because it’s easy for letters and calls to get lost in piles of other paperwork, contact your insurance company often. Make sure your requests are being attended to and find out when you may expect a response.
    • If your request has been rejected, keep trying. At some insurance companies, a customer's third request gets forwarded to a person with more responsibility and decision-making power.
    • Contact your state’s insurance commission. Many states have an insurance commission, an organization that oversees the sale and implementation of insurance, including health insurance. Your state insurance commission may be a resource for helping you with health insurance coverage problems.
    • Write to elected state and federal officials. Explain your position and ask for their support.
    • Let us know whether or not your health insurance organization covers your hyperhidrosis treatments. If you have had to go through an appeals process, tell us how it’s going. One of the International Hyperhidrosis Society’s goals is to improve access to hyperhidrosis treatments, including health insurance coverage for treatments. Any information you can provide about your experiences will help us as we work towards achieving this goal. E-mail your comments to info@SweatHelp.org.
    • Finally, while not technically insurance-related, clinical trials are another potential avenue for patients seeking treatment for hyperhidrosis. Clinical trials help to further medical science's understanding of a condition and its therapy. To learn more about open research studies in hyperhidrosis, how they can make treatment more affordable (even free), and whether you may be eligible to participate in a hyperhidrosis trial, visit the Clinical and Market Research page in the Take Action! section.
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