Home / Conditions / Plantar Hyperhidrosis
Plantar Hyperhidrosis: when insurers say no, reviewers often say yes
In 14 published external-review decisions involving plantar hyperhidrosis, independent physician reviewers overturned the insurer’s denial 78.6% of the time.
Published decisions
14
2001–2026
Overturned
78.6%
11 denials reversed
What the insurer actually argued
Denials fall into different categories, and they don’t succeed equally — so the reason on your letter changes how you should answer it.
| Reason given | Decisions | Overturned |
|---|---|---|
Experimental/Investigational The plan called the treatment unproven. These turn on published evidence, so the appeal is a literature argument. | 10 | 90% |
Medical Necessity The plan said the care wasn’t medically necessary. The most common fight, and the most winnable. | 4 | 50% |
Typical time to a decision
20 days
Most land between 11 and 21 days
Handled as urgent
7.1%
Expedited when a delay would cause harm
What the reviewers wrote
Excerpts from the independent reviewers’ published findings — the actual reasoning, quoted, not summarised.
Where the denial was overturned
Findings: The physician reviewer found that Nature of Statutory Criteria/Case Summary: A patient has requested authorization and coverage for bilateral lumbar sympathectomy.Endoscopic lumbar sympathectomy for plantar hyperhidrosis is within the treatment ladder for refractory plantar hyperhidrosis. In this case, the provider documented that the patient has a poor quality of life due to a diagnosis of plantar hyperhidrosis. First-line therapy for primary hyperhidrosis includes topical aluminum chloride, iontophoresis, topical glycopyrrolate, oral glycopyrrolate, and biofeedback. Second-line therapy includes Botox injections, which can be painful and may result in muscle weakness.
Nature of Statutory Criteria/Case Summary: An enrollee has requested authorization and coverage for iontophoresis. This patient presents with palmar, plantar, and axillary hyperhidrosis that has only partially improved with Drysol, oxybutynin, and topical antiperspirants. The provider recommended treatment with iontophoresis. There are data from clinical trials reporting that iontophoresis can be successful in alleviating the symptoms of palmar or plantar hyperhidrosis in approximately 85% of patients treated. Iontophoresis is specifically indicated for the palms and soles of the feet, but there is a lack of data demonstrating similar efficacy in the axillae. Currently, iontophoresis is considered a first-line therapy for this patient’s palmar and plantar hyperhidrosis over the remaining alternative, Botox, given the pain associated with Botox injections at these sites.
Where the denial was upheld
Worth reading too — these show what an appeal has to overcome.
A 22-year-old female enrollee has requested bilateral lumbar sympathectomy for the treatment of her hyperhidrosis. Findings: The physician reviewer found that an article by Reisfeld and colleagues, which was submitted with this appeal, reports the results of 1312 patients with hyperhydrosis treated with endoscopic thoracic sympathectomy. However, the requested procedure is a lumbar sympathectomy, rather than a thoracic sympathectomy. A literature search of lumbar sympathectomy for the treatment of plantar hyperhydrosis reveals additional articles regarding the requested procedure. In 2007, Rieger and Pedevilla performed bilateral lumbar sympathectomies on 8 patients. They concluded that in all cases, pedal sweat secretion was completely suspended post-operatively. After a 3- to 8-month follow-up period, the anhidrosis persisted in all cases (100%).
Nature of Statutory Criteria/Case Summary: An enrollee has requested an endoscopic bilateral lumbar sympathectomy for treatment of her medical condition. Findings: Two physician reviewers found that the patient has been diagnosed with plantar hyperhidrosis; however there is a lack of verification and quantitation of this diagnosis. There is a lack of verification that the patient has failed tannic acid, glutaraldehyde, anticholinergics, tranquilizers, or certain nonsteroidal anti-inflammatory drugs (NSAID) which are required before considering surgical treatment of plantar hyperhidrosis. Moreover, a medication list for this patient has not been provided to establish that she does not suffer from secondary hyperhidrosis, which can contribute and/or cause plantar hyperhidrosis. There is some promising literature supporting the requested surgery.
Figures and quotations on this page come from 42,749 published decisions in the California DMHC Independent Medical Review dataset. These are California outcomes — every state runs an equivalent external review, but the rates here are California’s. Excerpts are quoted verbatim from the public record and describe this condition generally, not any individual case.
How to use this in your appeal
These outcomes come from California’s external review program — an independent physician panel whose decision binds the insurer. Every state has an equivalent, and internal appeals succeed even more often. If your care for plantar hyperhidrosis was denied, the published record says the denial is worth fighting.
SOURCE: CALIFORNIA DMHC INDEPENDENT MEDICAL REVIEW OUTCOMES (CHHS OPEN DATA) · DERIVED AGGREGATE STATISTICS ONLY · METHODOLOGY
Not legal or medical advice. Coverage Rights is a self-help tool that helps you prepare your own appeal. For advice about your specific situation, talk to a licensed attorney or your doctor.