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Most insurance companies do not mention laser treatment at all in their policies, and therefore some Hidradenitis Suppurativa (HS) specialists have had success in getting coverage when presented as a medical need with relevant studies cited.
Until present day, when Aetna has been denying coverage completely. The medical community has requested that those of us in the patient community raise our voices and let Aetna know that this is an important item in the toolbox of patient treatments.

Following is a sample letter that you can edit to reflect your personal circumstances.

Aetna Contact Information: https://www.aetna.com/individuals-families/contact-aetna.html

To whom it may concern,

I am writing as a very concerned (patient/family member/other) to request that Aetna reconsider its clinical policy bulletins on hidradenitis suppurativa to include coverage for lasers that destroy hair follicles such as the Nd:YAG, alexandrite, diode, and other similar devices.  I have been informed by health care providers that this is a good treatment option for this condition, but it is very difficult to access it since clear insurance guidance does not always exist or insurance policies specifically restrict access to it.  

The patient community and I believe that access to this treatment is extremely important because it will help lead to better quality of life for many patients, reduce risk of side effects compared to medications, and reduce costs to patients and insurance companies by reducing the need for expensive and risky medications.

There are now many studies that show lasers help for hidradenitis as referenced below.  These include randomized controlled trials and prospective trials of Nd:YAG and alexandrite lasers.  Inflammation in hidradenitis starts around follicles and early reduction of hair follicles can help reduce the number of lesions that arise and ultimately lead to scarring and the need for surgery and more complicated medications.  The use of laser is supported by the North American treatment guidelines for hidradenitis suppurativa and is recommended as part of treatment by the Hidradenitis Suppurativa Foundation.  

[IF APPLICABLE, INCLUDE THIS SENTENCE]  I have personally had laser treatments in the past and found them very beneficial, but (I had to pay out of pocket/have to constantly worry about insurance denials when we try to get it covered).

While the out of pocket costs are much lower for most patients than the out of pocket prices for biologic medications like Humira and Cosentyx after insurance and savings programs, the pricing for laser is often out of reach without insurance coverage.  The costs for charges to insurance companies would likely also be much lower even with a series of monthly treatments compared to medicines like Humira, Cosentyx, and Remicade that can cost $50,000 to over 100,000 annually.

Considering that these cost over $5,000 per month, if laser treatments were covered and it delayed the need for biologic use for a few months, it would still represent a massive cost savings in those months alone.  Only about half of patients respond to the very expensive available biologics, and most of the laser studies below show responses that are actually better than what the biologic studies have shown.  Moreover, there is no need for additional costs for lab testing for monitoring with something like a laser treatment, and the risks of things like infections and other side effects are also much lower with the laser.  Your policy already covers treatment of pilonidal cysts, which nearly 1/3 of patients with hidradenitis also have, and for which similar numbers of studies exist.  Hidradenitis is similar in many ways but affects many parts of the body and deserves similar treatment.

Hidradenitis is not a cosmetic problem and has impacts on patients that is more severe than almost any other dermatologic disease, but most other conditions like psoriasis and eczema have many more treatment options.  Hidradenitis patients deserve access the treatments like lasers that can minimize risks and seem to provide clear benefits.  I request on behalf of myself and the patient community that the clinical policy bulletins at Aetna be updated to include coverage of laser for hidradenitis.  We ask that you reach out to the Hidradenitis Suppurativa Foundation (info@hs-foundation.org), where expert physicians and patient advocates are available to help discuss this very important issue, as well as other coverage decisions that often affect and restrict the care we are provided.  

We know this has been a particular problem with Aetna denying pre-approvals for patients to receive laser treatment despite physician appeals. Hidradenitis has been understudied and under-treated for many years and even finding a physician that understands the condition is a major challenge so we strongly urge you to consider better and more efficient ways allow people with hidradenitis to get the care they desperately need.  Thank you for your consideration.  

Insert name (If Aetna customer, consider providing Aetna ID)

List of Studies

  1. Alikhan A, Sayed C, Alavi A, Alhusayen R, Brasasard A, Burkhart C, Crowell K, Eisen D, Gottlieb A, Hamzavi I, Hazen P, Jaleel T, Kimball A, Kirby J, Lowes MA, Micheletti R, Miller A, Naik HB, Orgill D, Poulin Y.  North American Clinical Management Guidelines for Hidradenitis Suppurativa: a Publication from the United States and Canadian Hidradenitis Suppurativa Foundations. Part II: Topical, Intralesional, and Systemic medical Management.  J Am Acad Dermatol. 2019 Mar 11
  2. Alikhan A, Sayed C, Alavi A, Alhusayen R, Brasasard A, Burkhart C, Crowell K, Eisen D, Gottlieb A, Hamzavi I, Hazen P, Jaleel T, Kimball A, Kirby J, Lowes MA, Micheletti R, Miller A, Naik HB, Orgill D, Poulin Y. North American Clinical Management Guidelines for Hidradenitis Suppurativa: a Publication from the United States and Canadian Hidradenitis Suppurativa Foundations. Part I: Diagnosis, Evaluation, and the use of Complementary and Procedural Management.  J Am Acad Dermatol. 2019 Mar 11.
  3. Tierney E1, Mahmoud BH, Hexsel C, Ozog D, Hamzavi I. Randomized controlled trial for the treatment of hidradenitis suppurativa with a neodymium-doped yttrium aluminum garnet laser. Dermatol Surg. 2009 Aug;35(8):1188-98. 
  4. Jain V, Jain A. Use of lasers for the management of refractory cases of hidradenitis suppurativa and pilonidal sinus.  J Cutan Aesthet Surg. 2012 Jul;5(3):190-2. doi: 10.4103/0974-2077.101377.
  5. Xu LY1, Wright DR, Mahmoud BH, Ozog DM, Mehregan DA, Hamzavi IH.  Histopathologic study of hidradenitis suppurativa following long-pulsed 1064-nm Nd:YAG laser treatment. Arch Dermatol. 2011 Jan;147(1):21-8.
  6.  Mahmoud BH1, Tierney E, Hexsel CL, Pui J, Ozog DM, Hamzavi IH.  Prospective controlled clinical trial and histopatholgic study of hidradenitis suppurativa treated with the long-pulsed neodymium:yttrium-aluminum-garnet laser.  J Am Acad Dermatol. 2010 Apr;62(4):637-45.
  7. Fradet M, Bulai Livideanu C, Katoulis A, Hegazy S, Bouznad A, Jendoubi F, Carlet C, Paul C, Konstantinou MP. Efficacy and tolerability of long-pulse Alexandrite laser hair removal for hidradenitis suppurativa. Eur J Dermatol. 2021 Jun 8. doi: 10.1684/ejd.2021.4061. Epub ahead of print. PMID: 34106051.
  8. Molinelli E, Sapigni C, Simonetti O, Brisigotti V, Giuliodori K, Offidani A. Alexandrite laser as an adjuvant therapy in the management of mild to moderate hidradenitis suppurativa: A controlled prospective clinical study. J Am Acad Dermatol. 2022 Sep;87(3):674-675. doi: 10.1016/j.jaad.2021.10.060. Epub 2021 Nov 11. PMID: 34774922.
  9. Fortoul MC, Macias Martinez B, Ventura Rodriguez D, Dallara M, Stelnicki EJ, Kamel G. A Retrospective Review of Laser Therapy for Treatment of Hidradenitis Suppurativa. Ann Plast Surg. 2023 Dec 1;91(6):758-762. doi: 10.1097/SAP.0000000000003690. Epub 2023 Sep 12. PMID: 37856194.
  10. Sehgal VN, Verma P, Sawant S, Paul M.  Contemporary surgical treatment of hidradenitis suppurativa (HS) with a focus on the use of the diode hair laser in a case.  J Cosmet Laser Ther. 2011 Aug;13(4):180-90.
  11. Abdel Azim AA, Salem RT, Abdelghani R.  Combined fractional carbon dioxide laser and long-pulsed neodymium : yttrium-aluminium-garnet (1064 nm) laser in treatment of hidradenitis suppurativa; a prospective randomized intra-individual controlled study. Int J Dermatol. 2018 Jun 16.
  12. Fabbrocini G, França K, Lotti T, Marasca C, Annunziata MC, Cacciapuoti S, Masarà A, Romanelli M, Lotti J, Wollina U, Tchernev G, Zerbinati N.  Intralesional Diode Laser 1064 nm for the Treatment of Hidradenitis Suppurativa: A Report of Twenty Patients.  Open Access Maced J Med Sci. 2018 Jan 7;6(1):31-34
  13. Zerbinati N, D’Este E, Ini L, Baruffato A, Premoli V, Calligaro A, Paulli M.  Clinical and histological changes in Hidradenitis suppurativa following 1064 nm nd:YAG intralesional laser treatment. J Biol Regul Homeost Agents. 2017 APR-JUN;31(2 Suppl. 2):131-140.
  14. Levoska MA, Nicholson CL, Hamzavi IH. A retrospective review of light- and laser-based management of hidradenitis suppurativa.  Semin Cutan Med Surg. 2017 Jun;36(2):67-74
  15. Caposiena Caro RD, Solivetti FM, Bianchi LPower Doppler ultrasound assessment of vascularization in hidradenitis suppurativa lesions. J Eur Acad Dermatol Venereol. 2017 Dec 10.