Botox for Migraine: Will Insurance coverage Pay?

When Elizabeth Roberts-Zibbel was 39, the complications she’d had on and off since childhood turned persistent. Her normal drugs couldn’t contact this each day ache. Determined for aid, she and her household physician started to debate a brand new remedy: botulinum toxin.

It’s possible you’ll know this drug by the identify Botox, Dysport, Mybloc, or Xeomin. It’s the identical injectable remedy that retains celebrities wrinkle-free.

However Roberts-Zibbel quickly realized that her insurance coverage firm wouldn’t cowl the price of the injections.

“I known as my insurance coverage, and so they gave me the runaround,” she says.

Her expertise shouldn’t be unusual. Many individuals with migraine face hurdles in getting insurance coverage approval for Botox or comparable drugs.

However as Roberts-Zibbel quickly discovered, there are a number of methods to spice up your possibilities of getting the inexperienced mild you want.

Attempt Different Therapies First

Most insurance coverage firms say it’s essential to strive different ache aid choices earlier than they’ll approve Botox or comparable drugs, says Kiran Rajneesh MD, director of the neurological ache division at The Ohio State College Wexner Medical Heart.

These choices embrace:

  • Way of life adjustments equivalent to quitting smoking, lowering caffeine, and eliminating drawback meals.
  • Medicines that halt migraine ache, together with aspirin, ibuprofen, or triptans equivalent to rizatriptan and sumatriptan.
  • Medicines you are taking each day to stop migraines, together with beta-blockers, tricyclic antidepressants, or antiseizure drugs.

It often takes attempting a minimum of two various kinds of migraine drugs earlier than insurance coverage will OK Botox, Rajneesh says.

See the Proper Doc

Be sure you’ve locked in a neurologist or different headache specialist if you wish to strive Botox or comparable meds on your migraine. Rajneesh says insurers could also be extra prone to cowl the remedy in case you’re getting it from a neurologist.

Roberts-Zibbel clued in to this tactic via calls to her insurance coverage firm. She made an appointment with a neurologist, and finally her insurance coverage authorised three rounds of Botox.

One attainable snag is the wait time.

“Nationally there’s a scarcity of neurologists, and the wait time to see a neurologist is fairly lengthy,” Rajneesh explains.

His recommendation: Begin along with your major care physician and coverings like life-style adjustments and triptans whereas ready for a neurology appointment.

Preserve a Headache Diary

Come ready with all of the deets on your physician’s go to. This may assist in case you would profit from Botox and comparable medicines.

Rajneesh recommends printing out a clean calendar web page the place you report each day details about your migraines, equivalent to:

  • What number of days a month do you get them?
  • How lengthy do they final?
  • Do you see an aura?
  • Are there any components that set off your migraines, like lack of sleep?

Carry Your Data

Your doc must know which remedies you’ve already tried to allow them to see the entire image of your remedy historical past.

“A number of occasions sufferers will inform me, ‘I’ve tried drugs,’ however they’ll’t identify the drugs,” Rajneesh says.

“If I do know what you’ve tried, and I see you’ve tried them for a minimum of 2 months, which may give us a shortcut to maneuver to the therapies which may enable you to eliminate your complications.”

Should you’ve had a CT scan or MRI of your mind, convey these alongside, too. Rajneesh additionally recommends letting your physician find out about any various therapies you’ve tried, equivalent to bodily remedy, therapeutic massage, or acupuncture.

Ask an Skilled to Weigh In

Should you’re listening to “no” out of your insurance coverage firm about this kind of med, ask your neurologist in the event that they’d be prepared to name your insurer in your behalf.

Some insurers enable docs to request a case overview by a peer physician. Often this course of occurs over the telephone.

Your physician may also write an enchantment letter explaining your well being historical past.

Keep Constructive

Should you’re feeling daunted by the authorization course of for Botox and comparable drugs, take a breath, take it a step at a time, and switch to the consultants.

“Don’t really feel overwhelmed,” Rajneesh says. “Medical professionals are right here that can assist you. That’s step one: seeing one in every of us so we will get the method began and enable you to via it.”



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