Insurance

[sharoncole]

For about 12 years I had BCBS pay for my botox injections post surgery. This year I have Medicare and they are not covering the actual botox medication. If anyone is getting coverage, what is your actual diagnosis code your doctor uses?

[donjehle]

Hi sharoncole!  And thank you for your first post on the ANA Forums!

I am sorry that don't have the diagnosis code for the botox injections.  Hopefully, someone else can help you with that soon.

But some people on the forums have been considering botox, and I was wondering if you would be willing to share your experience with it?  You must see some value of doing it if you have been doing it for 12 years.  What benefits or problems have you had with botox?  It would be great for our community if you would share what it has been like for you.

Thanks,
Don

[sharoncole]

My neuroma was called a "sticky neuroma", was 3cm , and stuck to the 7th and 8th cranial nerve. My lip droops,and the nerve damage affected my smile,my eye closure, winking, puckering...The Botox helps with the pain and disfigurement.My neck muscles pull downward and are stronger than my facial muscles. Therefore, my neck muscles win! It is painful when they pull your face downward ! I also have twitching in my eye and cannot completely close it. The Botox relaxes the eye as well. Previously, I received several injections in my neck and around my eye and that worked well for about 12 years.I go about every 3 months for injections.For about the past year I am doing better without as much botox around my eye as far as closing it. My diagnosis has been Myokymia, Synkensis, and Lagophthalmos. BCBS covered it. Medicare doesn't cover Botox except for certain diagnosis. There is a diagnosis similar to mine that it does cover called Hemifacial spasms.I am now waiting on UTSW to help me with an appeal.Medicare covers only a portion of the bill and hasn't paid for the actual Botox itself which is $750!

[donjehle]

Thank you for sharing your story!  It is people like you who inspire me!

I was hoping that someone would have shared the actual diagnosis code they have used.  If you find what works in your appeal, please share it with the ANA community.  I really appreciate what you have contributed so far!

[alabamajane]

I have been getting Botox for several years now and Medicare pays for most of it.

Looking at last bill,, I had a 1 unit injection ,, I guess the code used was J0588, they charged $625 and Medicare approved the amount of $252.90 and paid $174.97. ( my BCBS secondary ins.  paid the rest).
The other entry says “ injection of chemical for paralysis of nerve muscles on side of face” ( 64612-RT) it was charged at $130 and approved for $129.63 and Medicare paid $103.71.

So charged was a total of $755.00 ,, Medicare approved amount $382.53 ,, Medicare paid $278.68 and my BCBS picked up the rest ( $103.86).

Hope this helps you some. That was taken from my quarterly Medicare statement.

Jane

[4givvvn]

I've had a similar experience with insurance coverage for my medical treatments. It can be frustrating when insurance plans change, and what was covered before may no longer be covered. In terms of diagnosis codes, it can vary from person to person and depend on the specific medical condition being treated. It might be helpful to consult with your doctor or contact Medicare for more information on specific diagnosis codes to assist you with coverage.

Or, consider exploring other insurance options to find a better plan. I used this health insurance marketplace when I wanted to change my plan, and they provided valuable assistance. Top-notch work from their side. They can help you find affordable health insurance plans that fit your budget and healthcare needs.