Ok- so I've been having botox injections about every 3 months for while now.... My old insurance (that I went off of in May) denied coverage for the botox, saying that it was experimental, or something else like that. I don't have the EOB infront of me right now. ANyways, I'm appealing their decision, and was wondering if anybody here has done that. What is the best info to have, and does anyone have supporting documentation or information?
sorry for rambling.

maybe Mr. T will just pity the fool at the ins. co, and they'll cover it.

If your dr has a good strong letter explaining why it is required to keep you functional and working...
and maybe a letter of dx from a couple of drs???

I don't know know many you had to see that were knowledgeable...

Hi dabbo,
I had appealed lots of denied things for my kids and got them through. Especially if you have a history of them helping. They may just give approval for some first to see if they still are helpful. Best docummentation is from the doc doing the procedures and you medical records.
Tell them they are the longest lasting of the treatments to take enough of the pain away for you to maintain work and not have costly surgical procedures. Just my thoughts.
Good luck
di

i mentioned once before that my insurance would only cover them for a dx of cervical dystonia. make sure that one is on there with the TOS dx.

also, for BCBS there is a place on their website where i can look up all of my coverage details...do you have something of that sort? It took many conversations with one of the phone folks to find that out.

Mine was denied also saying the same ole same ole.
When Dr. Jordan had the secretary copy the PDR pages on botox & send in, thats all it took for my attorney to say here...I got it ok'd. I go for my first one Aug 6th. 3 months of helping?? I was hoping for longer.

Anyways what hasbotox helped with TOS patients here?
Cyndy

My mom has cervical dystonia. she gets botox. It lasts between 3 and 4 months for her.

cyn- what was on the PDR pages? I read over my Dr's notes for the particular date, and it pretty much states why we chose to use botox. If it helps for cervical dystonia and THAT's covered, why wouldn't they cover it for this? It works in the same way. come to think of it, I may have a Dx of "slight cervical dystonia" from one of the neuro specialists i saw.... hmmm. now i gotta find where I packed that stuff.

DABBO
Look up Botulism, blah blah .... pages. And Johana is right DYSTONIA is the key word.
Cyn