Botox for Hemifacial Spasm Covered by Insurance?

Your insurance may be able to cover your treatment. The best thing to do is to contact your insurance provider to find out if your treatment would be covered.

I would contact the plastic surgeon, ENT, oculoplastic surgeon, neurologist or dermatologist that you plan to use and ask to speak with their insurance staff to inquire about their specific experiences with insurance coverage which can be regional and vary state by state, by insurance plan and by insurance policy.

I have treated several patients for hemi-facial spasm. We have not had good success getting the Botox covered by their insurance companies. However, the doses typically need are small 4-12 units in my experience so at least the cost is low. Hope this helps.

Ostensibly, use of Botox for certain medical conditions like hemifacial spasm, essential blepharospasm, spasmodic dysphonia are covered by insurance companies.  However, this varies with the company, the individual policy, and sometimes luck of the draw.  As Dr. Shelton stated, many insurance companies will "pre-approve" a claim, only later to "de-approve" the same claim for no particular reason.  I always advocate that in situations like this, the patient should become actively involved in motivating the process to move forward.  Call your insurance company.

Botox has been used for conditions such as hemi-facial spasm far longer than for cosmetic uses. As a matter of fact, it was treatment of bleharospasm (eyelid twitching uncontrollably) that led to the discovery of Botox for cosmetic wrinkles. If the causes are well documented and you have been evaluated by a qualified specialist in conditions such as these, insurance may cover treatment. This will also depend on coverage issues and if you chosen doctor participates in the insurance plan.

Your insurance companu may cover some of the cost of botox injected for hemifacial spasm. Even when surgical procedures are precertified by medical practices contacting the insurance company, there are times that after the treatment the company does not honor their initial claim.

It would be unusual for this type of treatment not to be covered by health insurance.  BOTOX treatment for facial spasm is one of the original FDA indications for BOTOX.  It is considered a medically necessary treatment and can be very effective.  These types of treatments are usually administered by neurologists, neuro-ophthalmologists, oculoplastic surgeons, and otolaryngologists.  

Check with your doctors office to be certain they accept your health insurance.  An experienced office will most likely have previously billed your health insurance company  for this type of treatment for another patient.  Find out if your insurance company requires prior authorization for this service before it is performed.  There should be a phone number on the back of your insurance card so that you can call and ask these types of coverage questions.  Don't go to an office that only does cosmetic BOTOX for this type of service.

Some insurance companieswill cover botox injections for spasm, migraines, etc.  The only way to know, though, isto call your insurance company and ask them two things - is it covered under my benefits and what do I need to do/ information needed to get it covered.  If you do not have this info. beforehand, chances are you will have to pay for it that day.

BOTOX for hemifacial spasm is usually covered by medical insurance.  You can call your insurance provider to find out for sure.

You should discuss this with the office of the injecting doctor, not here! It may be an insurance covered benefit, but I do not know what insurance plan you have - HMO, PPO, PCP, Medicaid???

Dr. B MIAMI