Spasmodic Dysphonia Bulletin Board

Is Botox covered by Insurance
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Posted by: mark lieberman ®
07/08/2006, 18:18:57


I have my 1st botox treatment scheduled for next month. Right now, Humana thinks it is is for cosemetics. I am hoping that the doctors office will provide all the neccessary documentation to show Humana that this is a treatment for a voice disorder.

I just want to know from other people, has your Insurance covered the botox treatments? Any complications?

mdl0477@yahoo.com
ABSD 5/1/06




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Re: Is Botox covered by Insurance
Re: Is Botox covered by Insurance -- mark lieberman Top of thread Archive
Posted by: Alison ®
07/08/2006, 21:36:13


Hi Mark,
I had my first Botox in December 2005. Initially my insurance denied the botox (I had to go through a prior authorization process). I appealed the denial and the appeal was reviewed by an anesthesiologist who overturned the denial saying botox was the standard of care for SD. So, it added a lot of time to the whole prior auth process but eventually was paid.
I am sure your doctor will know to submit documentation to support the medical necessity, and to make it clear that it is not cosmetic.
If I can help anymore let me know. I happen to work for the insurance company that did my initial denial so I learned a lot of the ins and outs of getting things approved. If you want you may e mail me directly: AlisoninLV@aol.com



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Re: Is Botox covered by Insurance
Re: Is Botox covered by Insurance -- mark lieberman Top of thread Archive
Posted by: mdubovick ®
07/09/2006, 13:44:36


The key to having my insurance company pay is a letter from my Otolaryngologist who diagnosed me. He said and I quote:

"SD was a neuromuscular disorder of the larynx which causes a strained and strangled quality of the voice which is difficult or impossible to understand. There is presetnly no cure for this disorder. however, partial paralysis of the vocal corads by injection of botulinum toxin is the best treatment available. These injections usually afford the patient anywhere from 2 to 6 months of relief from their symptoms. Unfortunately, the affects of botulinum toxin wears off and the patient requires reinjection. This goes on indefinitely. For approximately 2 to 3 weeks after each injection, the patient's voice is quite breathy and sometimes makes it difficult for them to continue work during this time, especially if they have to use their voice a great deal at work."

The above letter convinced United HealthCare to cover my Botox shots.




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Re: Is Botox covered by Insurance
Re: Re: Is Botox covered by Insurance -- mdubovick Top of thread Archive
Posted by: mark lieberman ®
07/09/2006, 19:02:48


When I called Humana, I got two different answers. But, the doctors office knows what to do and I know that once they tell Humana about my ABDS and the treatments, they hopefully will cover it.



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Re: Is Botox covered by Insurance
Re: Re: Is Botox covered by Insurance -- mark lieberman Top of thread Archive
Posted by: NSDA ®
07/11/2006, 10:21:36


Hi, Mark,

You may also want to consider contacting the Botox Reimbursement Hotline. They may be able to assist coverage and reimbursement policies along with assisting with patient specific insurance verifications, prior authorizations or claim appeals.

www.botoxreimbursement.us
Phone: 800.530.6680

Hope this is helpful.




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Re: Is Botox covered by Insurance
Re: Is Botox covered by Insurance -- mark lieberman Top of thread Archive
Posted by: Barbara S. White ®
07/11/2006, 12:23:13


My insurance has always covered botox with no questions. I have Medicare and Blue Cross. I think most insurance covers it but I have heard a few on the BB say theirs was not covered so not sure.

Blessings,
Barbara




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