ANA Discussion Forum

General Category => Insurance => Topic started by: Kristena on June 01, 2015, 08:47:02 am

Title: Insurance Denied for Botox
Post by: Kristena on June 01, 2015, 08:47:02 am
After over a year of having my insurance cover periodic Botox injections for synkinesis, they denied my last claim, calling it "cosmetic" and "experimental." Does anyone have advice for filing an appeal? Words or phrases that I should use or avoid? I'm going to state that the Botox is really for pain management for the muscle tightness and cramping--maybe even talk about how my vision can be skewed when the muscles around my eye get tight. Any other ideas?
Title: Re: Insurance Denied for Botox
Post by: arizonajack on June 01, 2015, 09:19:44 am
After over a year of having my insurance cover periodic Botox injections for synkinesis, they denied my last claim, calling it "cosmetic" and "experimental." Does anyone have advice for filing an appeal? Words or phrases that I should use or avoid? I'm going to state that the Botox is really for pain management for the muscle tightness and cramping--maybe even talk about how my vision can be skewed when the muscles around my eye get tight. Any other ideas?

What you talk about isn't going to count for much. Submit a Dr's report that says it's medically necessary and not cosmetic or experimental.
Title: Re: Insurance Denied for Botox
Post by: Kristena on June 01, 2015, 12:45:10 pm
Good to know they will want a medical opinion, and not just my opinion!