HELP PLEASE Insurance Problems How did you pay for your Botox????

[Kara29]

My doc in Boston is doing Botox on me on March 3rd. The only problem is that it is 500 dollars a vial and my insurance compamy may not appove it after all the paper work has been filled out anyway. It's not FDA approved for IC and they say they have never heard of anyone doing it for this so it is not likely even for medicdal neccistiy for it to be covered. I tried to get as much information from them as I could before I go as I can NOT afford this at all!!! I won't know for weeks wether it is covered or not and I am worrying myself over it. We have Excellus Blue Cross and Blue Shild Blue PPO. Anyone have this problem and have it end up being covered or not?

Thanks,

Kara

[traceann]

Kara, can your doctor contact the insurance company for you stating it's purpose and that, yes, it is medically necessary? I would think that might help, if it came right from the doc in some form...but I know how many crazy hoops the insurance companies make us go through, they sure do make you work for the coverages sometimes! Hope it's covered for you!

[Jean12]

I am currently waiting for insurance approval for Botox too. My doctor has written a letter stating that is is a medical necessity. He is including my history for the past year and all the treatments/medications and combinations that have failed. He also said he was including study and article information showing that it seems to be of benefit to many patients.

Even though you are already scheduled, ask your Dr. to do the same. I also have a Blue Cross/Blue Shield PPO plan.

Jean

[IcyAngel23]

I had botxox done twice and my insurance company denied it as well. I had to pay $450 for it. I would split it with another patient of my drs. The dr would order it thru his office to get the lowest cost. Some insurance companies will pay for it. I went thru appeals but lost. I hope you have better luck. I did botox in 04 so maybe with it being in trials thay may cover it. From what I was told once Medicare sees it as a treatment the other companies will follow. I'm sorry you are having trouble paying for it. Maybe you can pay it off in monthly payments. I was billed for the botox so maybe that may be an option for you. Talk to your dr. Good luck.
Kristin

[K9wife]

A word of caution before you go ahead with it: BC/BS (Excellus) plans are famous for being "non-par" (non-participating) if not being used within their geographic area or by Drs in their areas....call the 800 number on the back of your card and speak with a rep, but make SURE to get a name. I am struggling at work right now trying to help a patient with that same situation( having a surgical procedure, but out of the area) and it has been one battle after another I'm afraid. This whole insurance thing can be pretty frustrating, can't it?!?

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Call the botox company and see if they will give you a reduced rate or donate the medication. Some of the pharmacy companies have compassionate usage programs. There are other IC centers injecting botox into the urethra, bladder and pelvic floor.

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[Kara29]

My Insurance will not cover it for any reason except for Migranes. Screw Them this is MUCH WORSE than Migranes. I battled all day with them and my Doctors Office Yesterday. It was going to cost over $2,000. Go figure, like I have that kind of money to throw around for something that may or may NOT Work. I can't afford it so I can't do it. There is no such thing as a payment plan for this. The doc has to go through insurance and the insurance charges you as much as they want. So.........the solution to my urgency and frequency.......I will post that on the bladder removal board.


Kara

[momw/ic]

My doc quoted me $1500 for my botox and said that if my insurance company denied it he would charge $750. So, we arranged to borrow the $750 from my parents and paid that up from "just in case". Well of course the insurance denied it and the doc's office said they sent in all of the info that the insurance co. wanted including medical necessity letters and medical journal articles.

Here is where my advice comes in: My doc came back and charged me another $750 saying that what I paid the day before the botox was my first installment. When we tried to fight them on it because we had proof of his original agreement he honored the agreement but sent me a certified letter releasing me as his patient. Now, I called the insurance co. and asked about appealing the decision and in the process I found out that they can send you the documentation from your doc. that they used to make their decision. So I had them send me copies of what my doc. sent them. Well, it was a small, flat envelope because my doc sent them nothing. Not even a letter of medical necessity! So, my warning is to plan to pay the full amount and get any agreements in writing. Since all of this we have received an additional notice that we owe $750 for my botox treatment. Apparently writing still means nothing. Also, ask your doc for copies of what they sent the ins. co. and keep them accountable. There is no telling how many times they don't really try to get ins. coverage for us.

The sad part about the whole thing is that the botox injections changed me life and really helped me and now I can't have it done again. Firstly because it is too expensive to continue to have to pay for and secondly because this fraud of a doctor is the only one within 6 hours of me who does the botox. The docs that are 6 hours away are not even on my out of network insurance coverage so that is not an option at all. So you see, I have found a treatment that gave me my life back. For the last 6 months I have been sleeping through the night and peeing about every 4-5 hours during the day. I have still had pain but with my pain management it has been much more manageable. Now that the botox is wearing off I am stuck to go back to living a life of sleep deprivation and constantly going pee and feeling like I need to pee. And the pain is much worse. It hurts so much to know that there is a treatment out there that works for me and I can't get it!

So that is my experience with botox, doctors and insurance.

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That is a bad insurance and doctor story! I am so sorry. Can you go thru an appeal with your insurance company? Ask them what the process might be. Also, if you tell your HMO that the one doctor on their list doing this is no longer doing it and you need to go somewhere else to maintain your health -- ask them who to report that to. As you know it will takes hours on the phone.

Also, perhaps you could gather a large pile of medical articles and proof and send it to the insurance company. Then if they don't respond call and get their fax number -- don't say anthing -- put a note on top and say, I haven't rec. a response, so I am sending you this information. (Fill the fax machine up)

I am so sorry this is so sad.

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[jpwilkinson]

We all need to keep pushing the insurance companies to pay for Botox treatment. The more claims they get for instills in the office setting, maybe they can actually see that it is cheaper for them to pay for the Botox. My doc charges my insurance $150.00 for the marcaine instills which I have weekly and they pay for them. If Botox treatments last up to six months, it would cost less in the long run.

[CinSin]

I am so sorry that all of you are having so many problems with Botox and coverage. I battled my insurance company and won with a first level appeal. My advice is to ask the doctor to go through pre-determination (not pre-certification). Ask the insurance company what they need exactly from the doctors office. After I was first denied with pre-determination and decided to go through the appeals process I found out that my insurance company has two departments. Patient services and another for Health Care Providers. A supervisor in patient services told me what my doctor needed to write in his letter of medical necessity (Apparently his first was a little vague). My doctor went back and tweaked his letter. The insurance company told me to also send them copies of published articles from medical journals. My urologist sent them three differenct articles that he had published. Then after a few weeks of battling - the doctor's nurse called the insurance company and told them they were denying me effective medical treatment. Poof, I was approved.

My doctor's office gave me a copy of everything he sent them so I could have this information at hand when communicating with the insurance company. It was quite a bit of information. Work with your doctors office and don't give up!!

I am sorry that a doctor would fire someone as a patient when he knows his service had such a positive influence on one's life.

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CinSin,

Congratulations on this appeal! What a wonderul contribution to share it with others on the board. It is a perfect step by step example to follow. The medical world is new and different to patients, so we have to learn how to function within it and be successful doing so.

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