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Convincing My Insurance for Botox Treatment?

My Botox treatment has been denied by my insurance for the first time after several years. I had an increase in migraines about six months ago so my neurologist prescribed Ajovy in addition to my Botox treatment. My migraines decreased and I continued the regimen, however today I got a letter denying my Botox treatment which was scheduled for 9/30. The Botox was denied because I am taking the Ajovy according to the letter. I’m going to file a grievance but what do I say that would yield the best results?

  1. Hi, precsa. Insurance denials are the worst. I'm sorry you're going through that. While I don't have personal advice to offer (I don't want to steer you wrong!), I thought this article might be helpful. The part about getting your doctor to back you up is especially important.

    Please keep us posted! -Melissa, team

    1. My insurance is also a stickler for this, Ive had Botox treatments for about 8 years now with 2 different insurance companies. Both required pre-auths for the payment, which is up to your doctors office to get. My doctor(neurologist) always puts in my notes at each visit about how it’s working along with other medications they’ve prescribed and that continued Botox treatment every 12 weeks and along with prescription medications are recommended.

      Although I have not had that prescription medication before but I’ve had a similar issue when my insurance didn’t want to pay for a new prescription (new generation $1300/mo) as they felt a different generic medication would do just fine. So my psychiatrist’s office contacted them and after they received required documentation they covered it.

      Oh forgot! They (ins) can go and pay for previous treatments. Follow the appeals rules and do that. Last appeal I had to do I called the ins company’s pre-auth and customer service office to find out what documentation they needed. Right now my Botox from 1/20 is pending but 4/20 is paid. Go figure?

      Sorry for so long. Hope it helps. My next Botox is 10/26.

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