Botox helps with headaches.
This is well known, and you can read my other blog for more information. The question then comes up, “Well shouldn’t insurance cover it?”
Ah. Health insurance. I can tell you in general, health insurance doesn’t want to cover things, particularly if they can be construed as being cosmetic. We see this in all areas where there can be grey zones: breast reductions, eyelifts, abdominal muscle laxity, Retin A.
There is good science to support migraines are helped by botox. Your plastic surgeon knows your headaches may be helped by botox. (Though some headaches do not respond to botox- so don’t think it is a sure thing.) We are not the ones who make the decision if it is covered or not. Your insurance company does.
So, the how to:
1. You need to show why traditional therapy has failed you or why you can’t do it. This should be done with your current treating doctor. Example: I had a patient who despite being on 2 different meds would end up in the ER for toradol shots and end up missing work. She had frequent headaches. Her treatment was failing her. She got approved.
2. You need to get preauthorization. Some insurance plans will say preauthorization is not needed, but in general if insurance doesn’t approve it ahead of time, I am wary they will cover it after. Particularly because botox is seen as a “cosmetic” wrinkle treatment, you need to have insurance okay it.
3. Get receipts from your treatment and notes from other doctors. You can help build your own case by showing your decrease in headache medication, ER visits, etc as a result of your botox treatment.
4. I have found the glabella area (between the brows) helpful, and the only area needing treatment in many of my patients. For some patients whose migraines are refractory and complex, you may need injections in the temporal area, neck, and other areas, and for these patient I would recommend a neurologist who specializes in botox treatments for migraines.