Need help for friend getting botox approved

[GregT]

Hey everyone. I'm trying to help a friend of mine get approval for a botox injection into certain pelvic floor muscles. She has Blue Cross insurance and they want to charge her for the botox specifically which, as we all know, is expensive.

Just wondering if there is anything specific that someone has had to go through to prove to their insurance company that this is not experimental and that it is commonly done. Sorry for my laziness in not just searching for it myself. I've only had 2 naps today covering 5 hours.

Thanks to anyone who can help.

Greg

[GregT]

Are people just not trying botox injections? I thought this was a very regular thing that Dr. Hibner did to many of his patients?

[nyt]

You might want to contact Hermajesty because at one time she worked to get approval for botox.

Medicare will cover botox for specific diagnosis and most insurance companies you can get them to pay if you use the Medicare argument. A lot, of it has to do with the codes that are used. I know with Obamacare there are a bunch of new codes so I'm not sure what would need to be in the appeal but should ask the doctors office what specific codes they would use. Below are some links that should be helpful.

https://www.botoxreimbursement.us/Resou ... elines.pdf

http://www.cms.gov/medicare-coverage-database/

http://www.botoxmedical.com/helpful-res ... print=true

http://webserver.anesthesiologynews.com ... &a_id=2520

[janetm2]

Hi Greg,
I had botox to the levitor ani pelvic floor muscles by mt colon rectal surgeon (prior to finding I actually had PNE). I have blue cross blue shield federal insurance and they charged the hospital the cost of the botox via preferred provider so my fight was just to get the hospital to stop trying to bill me. The insurance company wrote a separate letter restating what was said on the explanation of benefits sheet that I owed the provider nothing for the botox. The surgeon was the same however he never billed me (must have known it was part of the preferred provider expense). Not sure if this would be the case for Hibner but I do think he does it often but maybe he has the right info for insurance up front to get maybe pre approved, so the patient does not have to fight with insurance? Hopefully one of his patients can explain what they did or did not have to do?
Janet

[GregT]

Thanks two both of you, nyt and Janet.

Greg