Is Botox for Migraines Covered by Major Medical Insurance?

As you can see, it depends on your location and your insurance plan, as well as some of the coding used by your provider.  In Wisconsin, it doesn't matter what kind of doc you are, ie there is no bias against plastic surgeons.  That's because botox for migraines can be performed by rehab med docs, neurologists, chronic pain docs, anesthesia, or internal medicine.  My suggestion, however, is to stick with "core" physicians for those with the most experience with botox: plastic surgery, facial plastic surgery, oculoplastic surgery, or dermatology.

Overall trends regarding insurance coverage are on the decline.  In my experience here in Wisconsin, we fought for coverage and saw steady iimprovement from the late 1990's through mid 2000's.  In the last three years that has clearly been reversed, to the point that it is exceptional to get coverage at this point.  Sad, but true.  Especially since it is effective for those properly screened,  in the majority of cases.  Most patients also had to first  prove "failure or significant side effects" using other meds like beta blockers and imitrex. 

Call the benefits number on the back of your insurance card and ask them directly if Botox for migraines is a covered expense, as well as if there are restrictions (provider, frequency, proof of prior treatments). 

Some insurance carriers may reimburse partially the cost for Botox for migraines. You would need to check with your individual insurer and they may grant precertification, however, they will tell you that they donot guarantee payment, even if they do precertify it.

Some chronic migraine sufferers who have failed traditional migraine treatments will benefit from Botox. I have several patients who have had life changing benefits from Botox. About half of their insurance companies cover the treatment the other half, unfortunately, need to pay out of pocket. It is possible that the recent FDA approval will help obtain authorization for this treatment in certain patients. Seek out an experienced injector since Botox treatment of migraines is not the same as cosmetic wrinkle treatments with Botox.
Best,Stephen Weber MD, FACS