Botox Treatment Insurance Coverage

[LADavid]

I was under the impression that Botox treatment for synkinesis was a normal medical procedure.  Someone suggested the other day that it is experimental and not covered by insurance.

Does anyone know?

David

[oHIo]

David...I think it depends on how your doctor codes the procedure.  I haven't received any insurance information yet.  I had mine two weeks ago and the doctor's office assured me they had never had a problem with payment.  I did not end up calling my insurance company to find out if it was covered.  I'm sure when my insurance company sees I went to a plastic surgeon (who specializes in facial nerve paralysis) and had Botox injected into my face, they'll be questioning the charges but I will be happy to send them a picture and they will realize my crows feet are still there. 

My doctor actually took pictures and a video of my synkinesis prior to the procedure.  Taking the video took longer than the procedure. 

Botox is approved by most insurance companies for things like tight heel cords (people with CP often have tight heel cords).  Botox is usually denied for things like migraines, but I have seen some insurance companies pay for it.  I will ask the doctor on Friday what diagnosis and codes they use to get payment.  And I'll let you know if I get a bill. 

[oHIo]

David...wanted to let you know my insurance did cover the entire cost of the Botox.  They considered it a surgical procedure.  Not sure I am going to do it again, but it was definitely covered.  Office said using the codes they use, they've never had an issue with denial.  Not sure what codes are used as I don't have my EOB sitting right here, but if you need to know, let me know.
How is your synkinesis doing?

[Janet]

I had Botox every 3 months to help with uncontrolable muscle tightning that was triggered by occipital nerve irritation. I was in a study (at no cost) that showed it did help. When the study was over, the insurance paid 100%. Once I had the root problem repaired, I no longer needed it. My doctor (headache neurologist) did to write a letter to the insurance company to explain.

Janet