As a chronic migraineur considering Botox injections (onabotulinumtoxinA) for migraine prevention, making the decision to pursue the treatment is but one tiny step on the road to actually getting the procedure. While the process of finding out whether your insurance company will cover them and what you’ll have to do to find out may seem overwhelming, it’s actually quite straightforward once you learn how it works.
Once you decide you want to try Botox injections for migraine prevention and have found a doctor who thinks you are a good candidate, you’ll want to find out how much it will cost to get them. After all, once you’ve tried all the first line approaches for migraine prevention the treatments seem to become increasingly expensive. Not to mention increasingly invasive!
The process for determining whether your insurance company will cover Botox treatment for your chronic migraines is called Prior Authorization. Your doctor and his or her staff will prepare a request for the insurance company that details your history with migraine disease and establishes that you have been diagnosed with chronic migraine. The insurance company answers this request by saying yes, it will cover the procedure or medication, or no, it will not. Because of the expense of the medication itself, almost every single doctor performing Botox injections will follow this process.
The FDA has approved the use of Botox injections for prevention of chronic migraines (see Botox Approval for Chronic Migraine: What Does This Mean?), so the chances are very, very good your insurance company will cover the procedure if you meet the profile of someone who may be assisted by the procedure. Many insurance companies denied coverage of Botox before FDA approval because they could claim it was still investigational. It’s hard for them to say that now considering the information required by the FDA to establish efficacy and safety.
You can help your doctor and his or her staff increase the chances of an approval by providing information to support the request. While your doctor’s office certainly has a file of information about you, often that information is not as complete as what you may be able to provide. If you bring your doctor a list of the medications and treatments you’ve tried in the past and a detailed calendar of the frequency and intensity of your migraine attacks, this will help the staff immensely in doing their job.
What additional questions do you have about this process? Please share them in the comments.