Case Study
Hyperhidrosis: A Navigation Success Story
How Mishe care navigation redirected a member from $150K–$200K in surgical claims exposure to a reversible, conservative path in 7 business days.
$138K–$188K3-yr savings vs. surgery
~$12K3-yr conservative cost
$150K–$200KSurgical cost
7 daysReferral to appt. scheduled
Plan Type: Self-Funded EmployerTPA: Marpai HealthReferral: Broker
Informational use only. Member identifying information removed. Not medical advice.
“Karen genuinely felt more like a friend than just a care coordinator. She made a difficult situation so much easier to navigate, and I always felt supported.”
Case Overview
- Member
- 26-year-old female, self-funded employer plan. Primary hyperhidrosis since childhood.
- Referral
- Broker with Marpai Health (TPA)
- Resolution
- 7 business days
Functional Impact
- Palmar sweating limiting professional meetings and handshakes
- Restricted clothing and footwear due to plantar sweating
- Social withdrawal since childhood
- Multiple prior treatments failed or abandoned due to system barriers
Clinical Background & Prior Treatment History
| Treatment | Outcome | Notes |
|---|---|---|
| Glycopyrrolate (oral) | Clinically ineffective | Did not achieve adequate sweat reduction |
| Drysol (topical) | Discontinued | Caused painful burning and skin irritation; not tolerated |
| Botox (palmar injections) | Abandoned: system failure | Located a provider but could not advance; insurance authorization delays and high out-of-pocket cost after 6+ months of navigation barriers. |
Key FindingThe member's abandonment of Botox was a navigation failure, not a clinical failure. The most effective, reversible, and lowest-risk treatment had never been genuinely trialed when she began pursuing permanent bilateral surgery.
Surgical Path Under Consideration
| Scenario | ETS (32664-50) | ELS (64818-50) | Total Exposure |
|---|---|---|---|
| K and B Surgical Center (Highest SCA) | $105,301.87 | $120,383.24 | $225,685.11 |
| Dr. Basseri / Dr. Reisfeld (Negotiated SCA) | $30,400.00 | $57,800.00 | $88,200.00 |
| Mishe Conservative Path (Bilateral palmar Botox) | N/A | N/A | ~$1,500–$3,000/session |
Against the highest SCA, Mishe's conservative path represents over $223,000 in avoided claims exposure.
Mishe Care Navigation: Plan of Care
- Day 1Case Referral
- Day 1–2Clinical Review
- Day 2–3Member Outreach
- Day 3–4Provider Sourcing
- Day 5–6Care Plan Presented
- Day 7Botox Scheduled
Immediate: Palmar Botox
Mishe sourced local providers performing bilateral palmar Botox injections. No out-of-pocket expense. Expected significant palmar sweat reduction within 2–4 weeks.
Next Level: Surgical Coordination
If member elects surgery after conservative trial, Mishe will negotiate SCA rates, price-compare 4 additional national specialists, and ensure complete informed consent.
Financial Impact & Cost Containment
| Scenario | Year 1 | Year 2 | Year 3 | 3-Year Total |
|---|---|---|---|---|
| Surgical Path | $150,000–$200,000 | N/A | N/A | $150,000–$200,000 |
| Mishe Conservative Path | ~$4,000 | ~$4,000 | ~$4,000 | ~$12,000 |
| 3-Year Savings vs. Surgery | N/A | N/A | N/A | ~$138,000–$188,000 |
$138K–$188K3-yr savings
~$12Kconservative cost
$150K–$200Ksurgical cost
7 daysreferral to scheduled
- Immediate claims avoidance: surgical path redirected before any claims were incurred
- Ongoing cost management: concurrent SCA negotiation and multi-provider pricing
- Stop-loss protection: conservative path eliminates trigger risk during Botox trial
- Post-surgical complication avoidance: ETS/ELS complications largely untreatable
Key Takeaways
| Benefits to Member | Benefits to Employer |
|---|---|
| Connected within 24 hours to a care team | Clinical appropriateness issues identified before claims |
| Accessed bilateral palmar Botox at no OOP expense | Claims fund protected; lowest-cost path pursued first |
| Informed of critical risks surgical center had not disclosed | Shielded from liability of uninformed member proceeding |
| Retains full choice; surgical path preserved | Price competition across 4+ specialists if surgery needed |
| Referral to scheduled treatment in one week | High-touch case resolved in 7 business days |
Internal use. May be shared with employer, broker, and TPA. Member identifying information removed. Not medical advice. | mishe.com