Insurance coverage for Botox

maddy Community Member April 27, 2007
  • What's the deal?  My insurance company will cover the cost of Botox but not to have it injected.  What do they expect me to do with it-smear it on?   I've had 2 treatments of the Botox and have another scheduled next week.  The first treatment didn't affect my migraines any but the second treatment along with a change in my prophylactic med made a big difference.  Does anyone understand insurance decisions and what they are based on?
5 Comments
  • Teri Robert
    Health Guide
    Apr. 27, 2007

    Maddy,

     

    Hello, and welcome to MyMigraineConnection.com!

    In this instance, I don't think it's an issue about the Botox specifically, but the way your doctor is billing. I've seen this with other injectable medications over the years, including simple vitamin injections. They expect the doctor to charge one fee that includes the medication and...

    RHMLucky777

    Read More

    Maddy,

     

    Hello, and welcome to MyMigraineConnection.com!

    In this instance, I don't think it's an issue about the Botox specifically, but the way your doctor is billing. I've seen this with other injectable medications over the years, including simple vitamin injections. They expect the doctor to charge one fee that includes the medication and whatever their fee may be. I also came across this when I worked for an insurance company. In most cases, the doctor charges the patient more for the medication than he or she pays for it. Thus, their time doing the injections is considered to be part of that ONE fee.

     

    Usually, if there's a problem with insurance and Botox, it's that they don't cover the Botox.

     

    Have you discussed this with your doctor or his/her billing staff?

    Thank you for creating a SharePost. SharePosts are a form of blogging, and there are many things you can do with them. You can share an experience, suggest something that's helped you, use SharePosts as a Migraine and headache journal, and many other things.

    We also have a discussion forum that you may want to check out. Especially if you have questions or are looking for information, you may find the interaction on the forum to be quite helpful. To get to the forum, just look for the orange box marked "Manage" and click on the Migraine Forums link. Because our forums are maintained by a third party, you'll need to register for the forum. You can use the same information you used to create your community log-in if you like. If you want to go directly to the forum, you can click HERE.

    Along with your personal "My Home" page and the discussion forum, you'll find links to a great deal of helpful information on the main page of our site, MyMigraineConnection.com

    If you have any questions, please feel free to post them to the forum or send me a message through my profile.

    Welcome again,
    Teri Robert
    MyMigraineConnection.com Lead Expert

     

    PS: If you receive this message from more than one of us, please excuse the overlap. Thanks!

  • Anonymous
    Suffering in SC
    Dec. 20, 2007
     I just wanted to add that I was treated for my migraines with Botox about a year ago and, after three treatments that seemed to be working well, my insurance company denied payment.  I had to quit taking the injections and my headaches are at an all time high.  I've been seeing a neurologist for over 30 years with migraines.  I've...
    RHMLucky777
    Read More
     I just wanted to add that I was treated for my migraines with Botox about a year ago and, after three treatments that seemed to be working well, my insurance company denied payment.  I had to quit taking the injections and my headaches are at an all time high.  I've been seeing a neurologist for over 30 years with migraines.  I've tried everything and had to quit several jobs because I couldn't make it to work for two weeks in a row without being absent.  I don't know what else to do...
    • Anonymous
      Pat
      Apr. 02, 2008
      Allergan, the maker of Botox, has a "BOTOX Reimbursement Solutions" program.  You never know, may qualify for help. The phone number is 1-800-44-BOTOX, press option 4.  Hope this helps.
    • Anonymous
      donna
      Apr. 04, 2009

      hi how does this work botox helped me i have been having since 19 i am now 55 and still get them i have been on just about everything .no luck i am on medicare and mainecare they paid once but not again

    • Anonymous
      Pat
      Apr. 04, 2009

      Allergan would not help either because it's not approved from migraines.

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