Why do I need an assessment before ETS surgery?

Because careful patient selection is the most important factor in a good outcome. ETS helps the right patients a great deal and is a poor choice for others. The assessment determines whether the benefits are likely to outweigh the risks, particularly compensatory sweating, for that individual.

Do I need a referral for ETS surgery in Ontario?

Yes. Assessment by a thoracic surgeon for hyperhidrosis requires a referral, usually from your family physician or dermatologist, as with other insured surgical consultations in Ontario.

Hyperhidrosis · Cost & coverage

Is ETS surgery for sweating covered by OHIP?

Q: Is ETS surgery covered by OHIP?

Yes. Endoscopic thoracic sympathectomy (ETS) is an insured surgical procedure in Ontario. For an appropriate candidate with a valid health card, the surgery, the anaesthetic and the hospital visit are billed directly to OHIP, with no direct cost to the patient. A referral and an assessment are required.

Q: Are Botox and miraDry for sweating covered by OHIP?

Generally no. Botox and miraDry for hyperhidrosis are not covered by OHIP. Depending on the plan, some patients receive partial support through private or workplace extended-health insurance such as Blue Cross, Sun Life or Manulife; patients should confirm with their own insurer.

Written and medically reviewed by Dr. Kashif Irshad, MD, MSc, FRCSC · Last reviewed September 2026

Short answer: Yes — endoscopic thoracic sympathectomy (ETS) is an insured procedure under OHIP. If you’re assessed and confirmed to be an appropriate candidate, there is no direct cost to you for the surgery, the anaesthetic or the hospital visit — these are billed directly to OHIP. But the more important question isn’t whether it’s covered. It’s whether it’s right for you, and that is exactly what the assessment is for.

When people first learn there’s a surgery for excessive sweating, the next question is almost always about cost. The good news is simple — and then there’s a more important point I want every patient to understand before they book.

What OHIP covers

ETS — the keyhole operation I perform for severe sweating — is an insured procedure in Ontario. For an appropriate candidate with a valid health card, there is no direct charge for:

the surgical procedure itself,
the anaesthetic, and
the hospital visit.

These are billed directly to OHIP, not to you.

How this is different from Botox and miraDry

Other treatments for hyperhidrosis work differently when it comes to cost. Botox injections and miraDry are generally not covered by OHIP. Depending on your plan, some patients get partial support for these through private or workplace extended-health insurance — such as Blue Cross, Sun Life or Manulife — but that varies from plan to plan, so it’s worth checking directly with your insurer. ETS is the option that, for the right candidate, is an insured OHIP service rather than an out-of-pocket one.

Coverage isn’t the point — patient selection is

Here is the part I care about most. Because ETS is covered, some people want to go ahead simply because it’s “free” — and I understand the appeal. But being covered and being the right choice are two very different things. ETS is a highly effective operation for the right patient, and the wrong one for someone else. The single most important factor in a good result is careful patient selection.¹

My job at the assessment is to work out, together with you, whether the benefits are likely to outweigh the risks in your particular situation — above all the risk of compensatory sweating, where the body can sweat more in other areas after the operation.^1,2 No matter how appealing “covered by OHIP” sounds, I won’t recommend the surgery unless I believe it’s genuinely the right choice for you.

My rule of thumb: the question is never simply “is it covered?” It’s “do the benefits clearly outweigh the risks for this person?” If the answer is yes, OHIP coverage means cost shouldn’t stand in your way. If it’s no, being covered doesn’t make it the right operation.

Who tends to be a good candidate — and who isn’t

Broadly, ETS tends to help most when the sweating is primary (not caused by another condition), focal — especially of the palms — severe, and hasn’t improved with first-line measures such as prescription antiperspirants. It’s less suitable in a number of other situations. Rather than generalise here, I’ve set out who is and isn’t typically a good candidate in more detail on the hyperhidrosis page and in Dr. Irshad’s Take. The self-assessment is a good first step before we meet.

How the process works

In practice it’s straightforward: you get a referral, we meet for an assessment, and if together we decide the benefits outweigh the risks for you, we proceed with the surgery through OHIP. If ETS isn’t the right fit, I’ll tell you that plainly and we’ll talk through the alternatives. You can also read an honest account of the trade-offs on the ETS risks page, and, if you live outside the province, coverage differs for out-of-province patients.

Common questions

Is ETS surgery covered by OHIP?

Yes. ETS is an insured surgical procedure in Ontario. For an appropriate candidate with a valid health card, the surgery, anaesthetic and hospital visit are billed directly to OHIP, with no direct cost to you. A referral and assessment are required.

Will I have to pay anything?

For an appropriate candidate with a valid Ontario health card, you should not receive a bill for the insured surgical care itself. The usual incidental costs around any surgery — parking, prescriptions, time off work — are not a fee for the operation.

Are Botox and miraDry covered?

Generally not by OHIP. Some patients receive partial support through private or workplace insurance (Blue Cross, Sun Life, Manulife and similar), depending on the plan — confirm with your own insurer.

Why do I need an assessment first?

Because selecting the right patients is what leads to good outcomes. The assessment is where we decide, together, whether the benefits outweigh the risks — especially compensatory sweating — for you specifically.

Dr. Kashif Irshad, MD, MSc, FRCSCThoracic & benign esophageal surgeon. This article is general information, medically reviewed September 2026. About Dr. Irshad →

References

Cerfolio RJ, De Campos JRM, Bryant AS, et al. The Society of Thoracic Surgeons Expert Consensus for the Surgical Treatment of Hyperhidrosis. Ann Thorac Surg. 2011;91(5):1642–1648.
Menna C, Ibrahim M, Andreetti C, et al. Long-term results of sympathectomy for palmar and axillary hyperhidrosis. Ann Cardiothorac Surg. 2016;5(1):26–32.

This article is general information and is not a substitute for individual medical advice or a coverage guarantee. Please consult a physician about your own situation.