More Botox questions

I recently got a letter that said my insurance has determined that Botox injections are medically necessary, thank God!! I am finally feeling hopeful for the first time in a long time.

It did say that "the approval does not guarantee payment. Payment is contingent on eligibility, contractual benefits, and care rendered in accordance with the rules, protocals and provider network of the member's Plan product on the date the service is rendered." This makes NO sense to me and I'll have to call tomorrow. Are they paying for it or not?

Anyway, my questions for you fine people are: how soon after Botox did you begin to feel better? Did the migraines stop instantly?

Also, is there anyone who was able to successfully go off of preventative meds after Botox? My hope is to stop Topamax someday.

I'm having my 1st round on Monday, August 15th. My hopes are up. I know it doesn't work for everyone, but I can't help but be excited. I might actually be ME again.

My interpretation of the response from the insurance company is that as long as your neurologist deems that you are eligible (i.e., you have chronic migraine) and that he/she is qualified and will perform the injections according to the FDA approved protocol (there is a standard methodology and dosing here) then you're good to go. It's always worth talking to them to ensure this is true.

After my first round of Botox, I got progressively sore over the day I got injected. Starting the next day I was feeling better, and by days 3-4 I was feeling MUCH better. From weeks 1.5-6 I would go 10 or 12 days at a time with no migraines. I was like...a normal person! The second time I got it I ended up with a wicked 3 day long migraine and it sadly was not that effective for me. There were some confounding factors here though, so I remain optimistic about my third session coming up in August.

If you had the type of success that I had with my first round then I wouldn't see why you couldn't go off of preventatives. I mean, what's the harm in trying? But I personally would ensure you had that type of success through 2 or 3 rounds of Botox before you stopped taking something that might be helping you. Just my two cents...

Good luck! Keep us posted!

I also agree I interpret that as approved. It also means that even though its approved, you still have to pay your portion, you have to still have the insurance at the time you get it, the doctor has to take your insurance, etc...lol lots of legal speak. Know your deductible & co-insurance level and ask your doctor what the cost of the medication + injection fees will be. The doctor fee and supplies for the injections is not just a co-pay typically, but subject to deductible + co-insurnace (as is the medication). I have heard one person so far whose Botox was covered under their Rx plan and doctor fee was covered as a co-pay, so thats pretty rare.

Price it out over the three months to judge how good of a value it is for you to keep that in mind as you judge your relief. Keep a migraine log before and after. Your insurance may require it for continued coverage (ask your doctor)...ie. if you don't get relief after 2-3 times, they won't want to keep covering it. I don't know how many actually check up on this though. Usually the pre-auth is more of a hurdle.

I don't have migraine, so my Botox results probably aren't applicable. Its pretty hit and miss sometimes. Best thing you can do is find an experienced doctor as the skill does matter (injection locations, technique, amount, etc), and see how you do with it. Yes, some people may taper off their preventative and us it instead, but often people who resort to Botox are the tougher cases and they may need both to stay at a good migraine level for them, or they may have not been on a preventative because typically insurance only approves Botox after you fail many preventatives or don't get sufficient (ie. typically 50% reduction) relief or they are untreatable.

I'm not sure about your insurance, as I don't live in the United States.

I have had maybe 6 sessions of botox and I find it hit and miss. I believe this is because my Neuro and I have been trying different doses and injection sites to find the most effective.

I think we have finally found what works for me. I found it kicked in after about a week and I have been 8 weeks migraine free (apart from my hormonal ones). I have found I have had a couple of headaches, but nothing I couldn't deal with and they were short-lived. I am not sure whether it will last for the whole three months - I guess I will find out soon enough.

The injections sting a little, but I think it is worth the short-term pain to be migraine free for weeks at a time.

I was taking Topamax before this, but had to stop due to the side effect of kidney stones. I am not taking any preventatives anymore.

I think it is possible to have botox work effectively and be migraine free for weeks at at time. Also to not take any preventatives. If it is covered by your insurance, it is definately worth trying it.

My only advice is to find a doctor who specialises in it for migraine. It may take a couple of times to find the right dose and injection sites. It also may not work on every type of migraine. I found Topamax worked for me and so does Botox, so maybe they work in a similar way.

Good luck and I hope this helps.

Thank you so much for your responses.

I called my insurance company. It was just a lot of legal-speak to mean that it is covered, and I need to pay my $15 co-pay. I think I can handle that.

I can't tell you how much it means to me to have this forum to ask questions to people who truly understand, and who have been there. My hopes and prayers go out to all of us for pain free days.

Wow thats awesome it'll be so cheap for you. And I thought I had good insurance at no deductible and 10% co-insurance. Good luck!

Sunny, that is a great deal! Even though mine is covered by insurance, I still end up having to pay $250 each session as my out of pocket expenses.

I wish you the best of luck trying this out. I think you are going to see great benefits.