When Elizabeth Roberts-Zibbel was 39, the headaches she had had since childhood became chronic. Her usual medicine could not touch this daily pain. Desperate for relief, she and her family doctor began discussing a new treatment: botulinum toxin.
You may know this medicine under the name Botox, Dysport, Mybloc or Xeomin. It is the same injectable medication that keeps celebrities wrinkle-free.
But Roberts-Zibbel soon learned that her insurance company would not cover the cost of the injections.
“I called my insurance company, and they gave me the solution,” she says.
Her experience is not uncommon. Many people with migraines experience barriers to getting insurance approval for Botox or similar medications.
But as Roberts-Zibbel soon found out, there are a few ways to increase your chances of getting the green light you need.
Try other treatments first
Most insurance companies say you should try other pain relief options before approving Botox or similar medications, says Kiran Rajneesh, managing director of the Department of Neurological Pain at Ohio State University Wexner Medical Center.
These options include:
- Lifestyle changes, such as quitting smoking, reducing caffeine, and eliminating problem foods.
- Medicines that stop migraine pain, including aspirin, ibuprofen or triptans such as rizatriptan and sumatriptan.
- Medications you take daily to prevent migraines, including beta-blockers, tricyclic antidepressants or antiseptics.
It usually requires at least two different types of migraine medication before the insurance gets Botox right, Rajneesh says.
See the correct document
Be sure to include a neurologist or other headache specialist if you want to use Botox or similar medications for your migraines. Rajneesh says insurers are more likely to cover the treatment if you receive it from a neurologist.
Roberts-Zibbel addressed this tactic by calling her insurance company. She made an appointment with a neurologist, and eventually her insurance approved three rounds of Botox.
One possible problem is the waiting time.
“Nationally, there is a shortage of neurologists, and the waiting time to see a neurologist is quite long,” Rajneesh explains.
His advice: Start with your doctor in primary care and treatments such as lifestyle changes and triptans while waiting for a neurological appointment.
Keep a headache diary
Come prepared with all the data for your doctor visit. It may help if you benefit from Botox and similar medicines.
Rajneesh recommends that you print a blank calendar page to record daily information about your migraines, such as:
- How many days a month do you get it?
- How long do they last?
- Do you see an aura?
- Are there factors that cause your migraines, such as lack of sleep?
Bring your records
Your doctor should know what treatments you have tried so that he can see the whole picture of your treatment history.
“Patients will tell me many times, ‘I tried medication,’ but they can’t name the medicine,” Rajneesh says.
‘If I know what you’re trying, and I see that you’ve been trying it for at least 2 months, it may give us a shortcut to go to the therapies that can help you get rid of your headaches.
If you have had a CT scan or MRI of your brain, bring it along as well. Rajneesh also recommends informing your doctor of any alternative therapies you have tried, such as physiotherapy, massage or acupuncture.
Ask an expert to weigh in
If you hear ‘no’ from your insurance company about this type of medicine, ask your neurologist if they would like to call your insurer on your behalf.
Some insurers allow doctors to request a case study by a peer doctor. This process usually takes place by telephone.
Your doctor may also write an appeal letter explaining your health history.
If you are afraid of the approval process for Botox and similar medicines, breathe, take one step at a time and go to the experts.
“Do not feel overwhelmed,” says Rajneesh. ‘Medical specialists are here to help you. This is the first step: to see one of us so that we can begin the process and help you through it. ”