Why Blue Cross Blue Shield Won't Cover Laser Treatment For Toenail Fungus

We’ve written before on the effectiveness of laser treatment as an option for people dealing with toenail fungus. The Wall Street Journal reports that “Published data on laser treatment for nail fungus is scant, but early results suggest it is a reasonable option for people who don’t want the side effects of oral medications.” PinPointe, a manufacturer of an FDA-approved toenail fungus laser, claims efficiency ratings as high as 71.4% — and another manufacturer, Nomir, says their Noveon laser cures 85% of patients.

toenail fungus laser

Image Source: DallasLaserMed.com

That makes laser nail treatment an attractive option compared to nail lacquers that see cure rates below 30% and oral pills that can cause side effects like liver damage. However, as you may have  heard, insurance companies do not currently cover the cost of laser treatment for fungal nails. What gives? We looked at the latest review by insurer Blue Cross Blue Shield to find out.

Are You In The Toenail Fungus Risk Pool?

According to Blue Cross Blue Shield, certain people are more likely to develop toenail fungus. Older people are more likely to develop onychomycosis due to decreased circulation, longer exposure to fungus, and slower nail growth. Furthermore, there are a number of co-morbid conditions associated with toenail fungus, such as: diabetes, obesity, peripheral vascular disease, HIV, and immunosuppression. People determined to be in the risk pool for toenail fungus may already be paying a slightly higher premium.

toe fungus

Image Source: Foot.com

How Is Onychomycosis Usually Diagnosed & Treated?

The presence of dematophyte toenail fungus can be confirmed by preparing a potassium hydroxide solution in the lab. Treatments typically consist of topical treatments with ciclopirox or amorolfine, as well as oral pills like terbinafine and itraconazole. However, Blue Cross Blue Shield admits that these remedies for toenail fungal infection “have low to moderate efficacy and a high relapse rate.” Treating fungal infections topically requires a long course of treatment and patient compliance, which is frequently an issue. Furthermore, oral antifungal medications have been associated with hepatotoxicity / liver damage.

laser toenail treatment

Image Source: FootProblems.org

Why Isn’t Laser Treatment For Toenail Fungus Covered By Insurance?

The insurer admits that “a potential advantage of lasers is that they have greater tissue penetration than antifungal medication and thus may be more effective at treating infection embedded within the nail.” They can also be done in a clinical setting over several sessions to reduce the burden of patient compliance. Officially, the company states that “the published evidence to date is insufficient to determine whether laser treatment improves health outcomes in patients with onychomycosis.” They say that additional studies using FDA-cleared devices compared to existing treatments or placebos are required before they are willing to cover laser treatment for fungal infections.

For now, the best we can do is talk with a podiatrist about our best options. Most people will try their luck with topical and oral antifungal agents that are covered by insurance. If you don’t like the low efficiency rates or the risks associated with these treatments, you can always pay $750 to $1,500 out of pocket for the laser treatment. No matter which method you choose to eliminate toenail fungus, be sure to invest in a SteriShoe UV shoe sanitizer to kill any living fungal spores present in your shoes, as they can re-infect you at any point during your course of treatment.


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