Is Botox for Migraines Covered by Major Medical Insurance?

The simple answer is yes. But I'm finding the majority of the insurers are refusing reimbursement to plastic surgeons since we are not internist or neurologist with detailed headache records on the patient. So for migrane therapy use a non plastic surgeon, for cosmetic Botox therapy ONLY use a Plastic Surgeon or Dem. 

As with most insurance-related questions, this all depends on a number of factors:

1) The insurance company - some insurance companies are more likely to pay than others.

2) The patient - many insurance companies will only pay for Botox if the patient meets the very specific criteria set forth by the FDA, when Botox was approved for migraine headaches in 2010. This includes 15 or more headaches per month, and 4 or more hours per headache. 

3) The amount - many insurance companies will reimburse only if the exact amount of Botox recommended by this same FDA study: 155 units over 7 muscular sites. If more or less is used, the claim could be rejected (even though many patients are known to not require the full amount)

4) The frequency - many insurance companies will pay for Botox only every 3 months, although some patients may require it more frequently.

5) The price - many Botox experts do not participate in insurance, and charge more than the insurance company is willing to pay. So even if your insurance company pays, you may be responsible for the difference between what the insurance company pays and what the doctor charges.

Regardless of the above factors, insurance companies typically respond to well-organized documentation and persistent follow up.

Most insurance policies require that you have tried several migraine medications without successful alleviation of the migraines. Only after will most insurance companies consider covering botox as treatment for migraines.