Botox for Migraine: Will Insurance coverage Pay?

When Elizabeth Roberts-Zibbel was 39, the complications she’d had on and off since childhood grew to become continual. Her typical medicines couldn’t contact this every day ache. Determined for reduction, she and her household physician started to debate a brand new therapy: botulinum toxin.

You could 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 referred to as my insurance coverage, they usually gave me the runaround,” she says.

Her expertise just isn’t unusual. Many individuals with migraine face hurdles in getting insurance coverage approval for Botox or comparable medicines.

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

Attempt Different Therapies First

Most insurance coverage corporations say you’ll want to attempt different ache reduction choices earlier than they’ll approve Botox or comparable medicines, says Kiran Rajneesh MD, director of the neurological ache division at The Ohio State College Wexner Medical Middle.

These choices embrace:

  • Life-style adjustments resembling quitting smoking, decreasing caffeine, and eliminating drawback meals.
  • Medicines that halt migraine ache, together with aspirin, ibuprofen, or triptans resembling rizatriptan and sumatriptan.
  • Medicines you are taking every day to forestall migraines, together with beta-blockers, tricyclic antidepressants, or antiseizure medicines.

It normally takes making an attempt a minimum of two several types of migraine medicines earlier than insurance coverage will OK Botox, Rajneesh says.

See the Proper Doc

Ensure you’ve locked in a neurologist or different headache specialist if you wish to attempt Botox or comparable meds on your migraine. Rajneesh says insurers could also be extra prone to cowl the therapy in the event you’re getting it from a neurologist.

Roberts-Zibbel clued in to this tactic by calls to her insurance coverage firm. She made an appointment with a neurologist, and finally her insurance coverage authorized 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 together with your main care physician and coverings like way of life adjustments and triptans whereas ready for a neurology appointment.

Maintain a Headache Diary

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

Rajneesh recommends printing out a clean calendar web page the place you file every day details about your migraines, resembling:

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

Deliver Your Data

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

“Lots of occasions sufferers will inform me, ‘I’ve tried medicines,’ however they will’t identify the medicines,” Rajneesh says.

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

For those who’ve had a CT scan or MRI of your mind, carry these alongside, too. Rajneesh additionally recommends letting your physician find out about any different therapies you’ve tried, resembling bodily remedy, therapeutic massage, or acupuncture.

Ask an Professional to Weigh In

For those who’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 keen to name your insurer in your behalf.

Some insurers permit medical doctors to request a case evaluation by a peer physician. Normally this course of occurs over the telephone.

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

Keep Optimistic

For those who’re feeling daunted by the authorization course of for Botox and comparable medicines, 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 will help you. That’s step one: seeing considered one of us so we are able to get the method began and assist you to by it.”





VLAYKO / Getty Pictures


Kiran Rajneesh MD, MS, director, neurological ache division; assistant professor, Division of Neurology, The Ohio State College Wexner Medical Middle.

Elizabeth Roberts-Zibbel, Bowling Inexperienced, OH.

Johns Hopkins Medication: “Botulinum Toxin Injectables for Migraines.”

American Migraine Basis: “Botox for Migraine.”

Mayo Clinic: “Migraine.”

Majersik, J. Neurology, June 15, 2021.

© 2021 WebMD, LLC. All rights reserved.

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