You shouldn't be rejected since the FDA approved Botox for migraines on October 15, 2010.
My insurance company rejected my Botox injections on the basis that they were experimental over a year and a half ago. After going through the steps with the insurance company, I got the State to overturn the insurance company’s rejection of it.
I sent a whole bunch of information (got it from my doctor) along with a letter from the doctor stating that my migraines were over 15 days a month and that I had unsuccessfully tried a variety of daily preventative migraine medications to treat my migraines to the State Insurance Commission. You will need to have your doctor include those 2 points in their letter to the insurance company to have any chance of it being covered by insurance.
Those insurance companies will try anything to avoid payments.
I've heard of this stunt before. Some 15 yrs after bone marrow transplants for leukemia were accepted practice, blue cross refused to pay for it because it was "experimental". The patient was a young single mother. Multiple petitions went to the insurance company, along with some threats to change our insurance, and it was changed. I like your method better.
7 Jul 2012
Hello sara12345. Good for you! Glad to read good news happening. Best of wishes, pledge
Now my Botox doctor says that he has no more rejections for Botox injections since we got the State to overturn the insurance company's rejection of it. But that's just the State that I live in.
7 Jul 2012
Hi Sara, hope the botox works for you. So far it hasn't helped poor ukliz. she is going back in the hospital on Monday for her horrible headaches. Just thought I'd let you know. Also, someone told me you commented after something I said about a headache study? I kind of remember that from last week when someone asked about migraines. I was referring to seeing a headache specialist that actually studies the type & kind of headache you have. I think you already know you have a bad migraine case. There is a headache institute in Chicago that has had wonderful success in treating all different types of headaches & that was what I referring to as a 'study'. Sorry if I misled you in any way. Wishing you all the best, & let us know how this works for you, please? thanks...
2 Nov 2014
I realize this comment is really old, but still feel the need to say... GOOD FOR YOU!!! I am impressed at your tenacity. As the old saying goes... "Always Question Authority." I used to work for a very well known health insurance company as a claims processor. Believe me, they will do whatever they can to deny claims. Whatever charges are submitted, even if it is clear in your policy that the charge is a covered benefit, they will find any little petty reason to deny a claim. And the reason they do this is that they rely on the assumption that most people will not fight the denied claim. And, unfortunately they are correct in that assumption. This is how they save money and stick it to their "valued" members. Obviously, you don't need to be told this... but for other people out there... never, ever, ever accept a denied claim as the final word and pay the resulting bill out of pocket.
Do your research and contact the insurance company with some ammunition they can't deny. Chances are they will realize that you are not one of the many who will just thrown in the towel and they will end up paying it. They will make it back on those who choose not to fight.
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