Insurance Denied for Botox

[Kristena]

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?

[arizonajack]

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.

[Kristena]

Good to know they will want a medical opinion, and not just my opinion!