FAQs Regarding Insurance Coverage of Botox or Xeomin
1. Is Botox or Xeomin treatment covered by my insurance company?
If you have third party medical insurance, your private drug coverage may cover Botox or Xeomin injections for certain medical conditions.
2. Which medical conditions are covered by insurance?
Botox injections for chronic migraine, hyperhidrosis (excess sweating) and temporomandibular joint (TMJ) or grinding may be covered by insurance. Rarely, a company may also approve
Xeomin for this use.
3. How do I know if I’m covered by my insurance?
You must contact your insurance provider to inquire about whether your particular plan covers treatment with Botox or Xeomin for the condition in question.
4. If I do qualify for coverage, what do I do next?
Your insurer is likely to require you to complete a form to request approval for the use of a neurotoxin (Botox or Xeomin) for your condition. They will supply the form. Typically, the form will require a section to be completed by you and a section to be completed by your family physician or the treating physician you hope to see.
5. Do I need an appointment before my first treatment?
Yes, you should book a consultation appointment with the doctor or nurse practitioner at ArtMed so that a proper evaluation and review of your past medical history and previous treatments can be undertaken to determine if Botox is appropriate for your medical condition. There is a $75 fee for this consultation appointment.
6. Can I bring the form to ArtMed to be completed by their doctor or nurse practitioner to my consultation?
Yes, we will complete the section that is required to be filled out by a medical professional. However, it is very important to understand that insurance companies will require information about your past medical history related to the medical concern. ArtMed cannot complete the form without this information. There is a $40 fee to have this form completed by our doctor or nurse practitioner.
7. Why is past medical history required?
Insurers are unlikely to approve your request for coverage unless you have tried other medical treatments or options first. In other words, they will not cover Botox treatments if you haven’t tried anything else before (for example drug therapy), or if you’ve not been previously seen and diagnosed by a medical practitioner for this condition.
8. What kind of past medical history information is required?
For chronic migraine: when were you diagnosed? How long have you had migraines? How often do you get them? How many headache and headache-free days do you have per month? Have you seen a neurologist? Have you had a formal diagnosis or diagnostic studies (eg. MRI) What medication do you presently take? What have you tried and not found to work? Have you had medication side effects or intolerances?
For hyperhidrosis: how long have you suffered with it? Have you been formally diagnosed by a doctor? Have you tried any treatments eg. Drysol? Did it work? How long did you use it? Did you have side effects or problems with treatment?
For TMJ: have you seen a doctor or dentist for this condition? Have you been fitted with a night guard? How long have you used a night guard? Has your dentist recommended treatment with Botox for TMJ? Why? (cracked teeth, gum inflammation, wearing away enamel) Have you used any medications to treat this condition?
9. Can anyone else complete the insurance form?
Yes, your family physician can complete the form which is especially useful if you’ve seen them before for your condition or if they’ve prescribed treatments for your condition.
10. If ArtMed completes the form, do I send it in?
No, we will send it in. Please carefully complete the sections you must fill out prior to your consultation and we will complete the sections that must be filled out by a doctor or nurse practitioner. At that point we will fax your form to your insurer.
11. How will I know if I’m approved or denied coverage?
Your form will be faxed by ArtMed to your insurance company for approval. They may approve or deny your request for coverage. You cannot proceed with treatment with insured coverage until you have approval from your insurer. It typically takes 5 to 14 days to hear back from the insurer. They will fax back their decision to our office. We will contact you then. If they approve your request, you can then proceed with booking an appointment for the procedure.
12. What happens if they deny my request for coverage?
You must take this up with your insurance company. You can certainly proceed with treatment and pay for it yourself. If you are considering that please book an appointment to discuss it with one of our doctors or nurses.
13. If approved, will my insurance company cover the full cost of treatment?
Your insurance company will only cover the cost of your medication (Botox or Xeomin) and will not cover the cost to have your treatment administered. Keep your receipts however, because the cost of administration is a medical expense and can be claimed at tax time. The cost for injection administration at ArtMed is as follows:
Chronic migraine $175 injection fee
Hyperhidrosis $ 225 injection fee
TMJ $150 injection fee*
*Some individuals will pay for the cost of their TMJ treatment up front and seek reimbursement directly from their insurer.
14. Can I do some cosmetic treatment with Botox at the same time?
You cannot use your insured Botox to treat for cosmetic purposes. In fact, this is considered insurance fraud. This doesn’t mean that you can’t treat for cosmetic purposes in cosmetic injection areas at the same visit, it just means that you will have to pay for the cosmetic portion of your treatment separately and at the usual rate for Botox or Xeomin ($10.60 per unit).
15. How often will I need treatment?
Migraine: every 3 months
Hyperhidrosis: every 6 to 12 months
TMJ: every 4-6 months
16. Is there anything else I should know?
Follow-up is important as is tracking the progress of your treatment. Insurance companies may on occasion audit you or your physician to see if treatment is being provided according to their requirements and standards. In the case of migraine patients, it is important to keep a heachache diary or use the Canadian migraine tracker (online tool). Regular follow up according to the timeframes set out in #15 above is recommended so that your progress can be tracked and recorded. Medication use, for TMJ changes in dental status (cracked teeth, periodontal issues etc) should be regularly updated in your chart.
To book an appointment please visit our booking page here.
