Health Insurance Obstacles: Toenail Fungus Considered a “Cosmetic” Issue and Not Included in Coverage

“I had Aetna tell me they wouldn’t pay for an anti-fungal prescription for my toenail fungus,” writes a reader of Truthout Magazine. The writer goes on to say that multiple appeals and biopsy results didn’t sway the insurance company to pay for an expensive medication, but they did concede that they would pay to have all the patient’s toenails surgically removed! Absurd stories like this are more common than you’d think because health insurers largely consider toenail fungus to be a “cosmetic” issue. We strongly disagree!

toenail fungus pills

Makers of toenail fungus medication are charging a fortune for their pills, but efficiency is questionable.
Image Source:bionapcfa.blogspot.com

Insurance Providers Say Toenail Fungus Is Just Plain Ugly.

The Frankel Foot & Ankle Center in Pennsylvania offers laser treatment for fungal nails, but specifically states that the treatment is “considered cosmetic and is not covered by insurance.” Therefore, their office does not submit insurance claims for the procedure or provide letters of medical necessity.

In fact, toenail fungus can show up as a black smear on your health history in some states. Ralf Burgert, a San Rafael, California, resident got the shock of his life when he tried to apply for a health insurance policy on the individual market. He was told that his previous prescription for Lamisil, a toenail fungus medication, put him into a “high risk insurance pool,” so is premium would be 50% higher than expected. Does that sound like a trivial, “cosmetic” issue to you?

toenail fungus cosmetic

Toenail fungus is more than just a cosmetic problem.
Image Source: Medscape.org

The Hidden Dangers of Toenail Fungus

As we mentioned in a previous post, there are many complications associated with toenail fungus — especially if you have diabetes or a weakened immune system. For starters, toenail fungus opens up the body to a wide range of infections. Bacteria, viruses, and other fungi can use the fungal colony as a way to penetrate the nail and skin barriers to get inside the host. Cellulitis, MRSA, and Staph infection can get into the body this way. These infections can lead to the loss of a limb for at-risk patients.

“Some patients and professionals see onychomycosis as an inconsequential cosmetic problem. However, because the nail supports and protects the toe and helps the foot work, onychomycosis can affect standing, walking, and exercising,” medical professionals state in a Medscape article. Pain, tingling, and loss of dexterity can interfere with work and school.

laser toenail fungus

Laser toenail therapy offers promising results for the treatment of toenail fungus, with limited compliance required on your part. The only bad news is that insurance does not cover the cost.
Image Source: FootCareSpecialistsPC.com

How to Treat Toenail Fungus Without Insurance

Unfortunately, all toenail fungus treatments are expensive. A mother wrote in to Amazon’s Askville website wondering how to treat the fungus on her son’s one toe. “His insurance will not pay for the prescription pills needed to cure it. The pills are over $200 per month,” she explained. Laser toenail fungus removal is even more expensive, with a price tag ranging from $500 to $1,200. Readers were quick to pitch in suggestions, ranging from vinegar soaks and Vicks VapoRub, to tea tree oil applications and grapefruit seed extract. Yet, there is no evidence that any of these home remedies for toenail fungus actually work. Your best bet is to pay for laser therapy out of pocket, and sanitize your shoes with a UV light shoe sanitizer to prevent toenail fungus recurrence.

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