Clusterheadaches.com Message Board


    
      
        Clusterheadaches.com Message Board
        (http://www.clusterheadaches.com/cgi-bin/yabb/YaBB.cgi)
      

        New Message Board Archives >> Medications, Treatments, Therapies 2003 >> Insurance Botox denial? Need studies to appeal!
        
(Message started by: dtruett on Mar 1^st, 2003, 1:59pm)

Title: Insurance Botox denial? Need studies to appeal!
Post by dtruett on Mar 1^st, 2003, 1:59pm

After months of serious headaches and a truckload of medication, I got a Botox treatment on Nov. 11. Starting a few days after I have been pain-free, a miracle. Since then my insurance company, Aetna, issued a bulletin denying Botox's use for ch or any headache, saying there weren't enough controlled studies, although it was a promising treatment. It stated that effective prophlyaxis could not be established. On appeal, they did not even consider me as an individual or how it was proven effective for me, just referred to their policy. Now I am appealing to the state of California. I was only able to find one study of Botox with ch and that was only ten patients. If anyone knows of more data to help me buttress my case. Botox injections are about $1000 per session and in some people (don't know about me yet) last only 3-4 months. I can't afford this. Any suggestions for less expensive treatment? Thanks.
Don Truett

Title: Re: Insurance Botox denial? Need studies to appeal
Post by nancyc on Mar 3^rd, 2003, 1:32am

If you find out anything,please let me know...my doc is having trouble with companion approving them for me too...he is gonna use my diagnosis of TMJ to see if they will consent to that one ...doubt it though.. good luck. smiles,nancyc

Title: Re: Insurance Botox denial? Need studies to appeal
Post by dtruett on Mar 3^rd, 2003, 8:17pm

NancyC,
Here's something to look at-a site I found with a Googol search. This site has 3 links to reimbursement strategies and sample letters the doctor can write:
http://www.imigraine.net/newrx/botox.shtml
The second one is the hotline link and has an 800 number. My interpretation is that the doctor's staff calls the number and the manufacturer (?) or whoever is at the other end of the phone contacts the insurance company and keeps the staff informed of the results:
http://www.imigraine.net/newrx/hotline.shtml
Please let me know if you try this and what you find out.
Don Truett

Title: Re: Insurance Botox denial? Need studies to appeal
Post by nancyc on Mar 4^th, 2003, 12:41am

thanks bro...i really appreciate this info...will keep you posted..smiles,nancyc