HELP: Running into insurance trouble!!

[momw/ic]

Ok all of you Botoxers I need your help. Tell me about your insurance company experiences with this. I am due for my first injections on Tuesday and today the docs office said the insurance may not pay. Do your pay? If so, how did you get them to cover it? I am frustrated at my docs office for letting this go until the last minute. Thanks in advance for your help - I really am wanting to do this...

Pam :headbang:

[Elle]

I haven't had it done, but I have checked on it w/ my insurance co and here's what I've learned...
Your Dr needs to make sure that it's well documented that you're getting it done for muscle/bladder spasms and not for cosmetic purposes (like we care if our hoochies have wrinkles! :biglaugh: ). The other problem may be that it is an experimental procedure where injecting it into the bladder is concerned. The way to get around that is by making sure that they know Botox IS FDA approved for other purposes and Drs have a right to use drugs for "off-label" purposes.
My advice would be to call your insurance co and make sure they approve it now. If you have it done and they deny it, you can appeal it in writing and explain why you had it done (i.e. "normal" treatments weren't working). If they deny it after the appeal, appeal again and request a review by a medical board. I've done that before and they suddenly approved me - I think they didn't want to be bothered with it, but it worked! I don't know what insurance you have, mine is BC/BS and they have agreed to cover it. I've just been too chicken to try it! Please let us know how it turns out!

[IcyAngel23]

pam -
My insurance didn't pay for the botox itself which cost $500 but it paid for the surgery. They bill it as a cysto with instillation. I had a lidocaine instill along with it to help with pain adter the procedure. Let me know if you need any other help.

Kristin

[Tunia]

Dear Pam...
Some hospitals will absorb the cost of the botox itself since this is an experimental procedure. Your Uro should be able to check to see if this applies in your situation.

Good luck with your injections!

[CinSin]

Hi Pam,

I had botox done six times and the first four was paid by my insurance company. But then I stopped working and we had to go through pre-determination with my husband's plan and it was initially denied but I won on the first level appeal.

I consulted with an attorney before filing an appeal. Read your policy regarding Botox. Mine said it doesn't cover experimental or investigational procedures but does pay if there is medical necessity.

The doctor wrote a second letter of medical necessity stating that I had failed all other conventional therapies, that the alternative to not having the procedure would result in much more invasive surgeries, increased emergency room and office visits.

Please email me at csinclair@icutexas.com and I will be happy to help you.

Cindy