Botox Treatment Insurance Coverage

[LADavid]

I posted this under insurance, but I also thought I would post it here for those of you who are getting Botox treatment -- DHM and Simon -- is Botox treatment for synkinesis covered by insurance?  Someone just told me that it's experimental and therefore not covered.

David

[Brendalu]

David,
Some insurance companies are covering it.  My insurance company is still deciding in my case.  I have United Healthcare Pro choice.  You should call your insurance company.  Possibly, it needs to have different billing codes when it is not used to freeze the wrinkles!
Good luck,
Brenda

[LADavid]

Thanks, Brenda

Since I already had my first treatment, I guess I'll wait to see if it goes through and then deal with it.  But knowing that just the word Botox will set off alarms with my Screen Actors Guild insurance -- I may be facing an uphill fight.

I can always hope.

David

[saralynn143]

I had one round of Botox injections for hemifacial spasm. It was covered, but the doctor had to do an exam and then call the insurance company before they would approve it. I imagine it would take the same procedure if I need it for synkenesis.

Sara

[Chambo]

Hi David

Most Specialist appointments in Australia are covered by our Federal Government based medical cover called Medicare. Others (like Physio, Osteo, Dental etc) are covered by Private Health Insurance.

Lucky for me our Government sees Botox for hemifacial spasms etc as non-cosmetic so I was hardly out of pocket for my 20 or so shots! My neuro was loving it as he could go nuts on me at pretty much no cost to me...!

I'm seeing him again b4 Xmas to get his thoughts on the first dose. So far so good - esp for the chin and neck muscles; they haven't moved since the injections which has been a massive relief to my overall face movement AND neck stiffness. My smile is able to work more naturally without my chin and neck muscles pulling it down.

I shall keep you posted mate and please do the same.

All the very best,

Simon

PS - apologies for our latest flick from downunder, "Australia". I haven't seen it but the trailers make me cringe with all the "crikey" calls. Looks way to cheesy... we're not like that; i promise!

[amymeri]

I have used Botox with 2 insurances (Aetna and Blue Cross).  Both covered it for my condition (facial paralysis, hemifacial contracture/spasm).  I had to be pre-certified by Blue Choice but then was okay'd for a year of treatments.  Aetna was easier to deal with.

The diagnosis code and procedure code needs to be correct and then it should be covered.  If your insurance rejects it initially your doctor can appeal, code it correctly and get pre-certified/pre-authorized. 

Every person I know has been able to get insurance to cover it on the affected side.  I really feel for people who can't get it covered because it isn't experimental and it isn't just vanity.  That's when insurance makes me insane...when it just turns into a game.

Sometimes (if you are using it on the un affected side to even things out) some of the injections won't be covered.  I find that my doctor just "gives" me the leftover in the needle and I can have it anywhere I want it.

good luck...

How is it working so far??

Amy

[CROOKEDSMILE]

Hi David,
My insurance company denied it at first and then once my Doctor sent the letter stating that it was a medical necessity for the paralysis/synkinesis then the insurance paid it right away. So to save yourself alot of trouble and having to wait for them to pay go ahead and ask the doctor to write the letter and send it in with the botox bill/claim and it should be covered. Now I know what to do and this is now customary for me anytime I go which is every 3 months for the injections....Is the botox helping yet? I got it in my chin for the dimpling and it went away and haven't had to have it injected there anymore. Now I just get it in my neck. I go to a doctor that instead of giving multiple injections she uses one very long needle and takes it all the way through the band of neck muscles and then as she pulls the needle out she disperses the medicine throughout. HURT like you know what. I've had botox alot since I had hemifacial spasms before surgery and I would suggest the multiple injections any day. She also did that all the way through my chin and she warned me that the chin was painful and she wasn't lying. I saw stars and started sweating. Needless to say.....this is still her way of doing it and I don't think I could change her. She is really good and runs the botox clinic at Vanderbilt. She thinks that this method works better?!?!?!? Anyway....the botox helps alot and allows freer movement of the muscles especially while doing strengthening exercises.
Good Luck.
Angie

[oHIo]

David..I responded on the insurance board, but I had Botox probably around the same time you did.  Insurance covered it without any precertification.  My doctor's office said they had never had it denied. 

How is it working for you?  Not sure I am going to do it again. 

[lifeisgood]

I had it covered via insurance when I drove to Wisconsin to have it done through the hospital.
Jackie Diels, the facial retrainer marked my face and then I drove to Dr. Mark Lucarelli who is an opthamolgist (Spelliing?)
shot me up.  He billed my insurance co over $1,000 and it was covered.  I ended up having the last round done in Florida from
a plastic surgeon.  He did both the affected and unaffected side.  So, I didn't even bother trying to get it covered.  It was $650.
I think it is sooooo important to go to someone who knows what they are doing especially when dealing with synkinesis which can be tricky.
I am thrilled with the results.  I had lines on only half my forehead and now I have none.  I've been told I look 10 years younger.
I think it will last around 5 months.

Mary

[4cm in Pacific Northwest]

As long as the phycians's office puts in the correct code (ie NOT "cosmetic") then it is covered...

DHM