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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.
Submit your request in writing. Write a letter to your insurance company. Include
copies of receipts for treatments not reimbursed, information about the
Cost of Hyperhidrosis, medical test
results, and statements from your physician
(including a Letter of Medical Necessity, Hyperhidrosis Preauthorization Request Form, and, for iontophoresis, a Medical Insurance Claim Statement Form
for the purchase of a home-use iontophoresis machine).
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.
Conduct research. Do other insurance companies cover the desired treatment? (Visit our links to public hyperhidrosis coverage policies for this information)
If so, mention them during your dealings with your own company.
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 clinical trials, 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 Getting Help section.
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Find a doctor who treats excessive sweating. |
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