Author Topic: Insurance Denied for Botox  (Read 4126 times)

Kristena

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Insurance Denied for Botox
« 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?
2.7 cm meningioma in CPA and IAC
Retrosig June 2013 resulted in Facial paralysis and SSD
6-mo post-op MRI showed 1.0 cm remains in IAC
3-yr MRI still shows no new growth!
6/2014 Baha magnet implanted; 8/2014 magnet removed due to poor healing; 9/2014 abutment installed. Hearing fine!

arizonajack

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Re: Insurance Denied for Botox
« Reply #1 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.
3/15/18 12mm x 6mm x5mm
9/21/16 12mm x 7mm x 5mm
3/23/15 12mm x 5.5mm x 4mm
3/13/14 12mm x 6mm x 4mm
8/1/13 14mm x 5mm x 4mm (Expected)
1/22/13 12mm x 3mm (Gamma Knife)
10/10/12 11mm x 4mm x 5mm
4/4/12 9mm x 4mm x 3mm (Diagnosis)

My story at: http://www.anausa.org/smf/index.php?topic=18287.0

Kristena

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Re: Insurance Denied for Botox
« Reply #2 on: June 01, 2015, 12:45:10 pm »
Good to know they will want a medical opinion, and not just my opinion!
2.7 cm meningioma in CPA and IAC
Retrosig June 2013 resulted in Facial paralysis and SSD
6-mo post-op MRI showed 1.0 cm remains in IAC
3-yr MRI still shows no new growth!
6/2014 Baha magnet implanted; 8/2014 magnet removed due to poor healing; 9/2014 abutment installed. Hearing fine!

 


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