Botox for Hemifacial Spasm Covered by Insurance?

i will be having botox next month for hemifacial spasm will i have to pay for it?

Doctor Answers 10

Contact your insurance provider

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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.

Insurance coverage of Botulinum Toxin (Dysport or Botox) for hemifacial spasm

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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.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

BOTOX for hemifacial spasm is usually covered by medical insurance

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

Joseph A. Eviatar, MD, FACS
New York Oculoplastic Surgeon
4.7 out of 5 stars 68 reviews

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Sometimes yes and sometimes no.

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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.

Ivan Wayne, MD
Oklahoma City Facial Plastic Surgeon
5.0 out of 5 stars 65 reviews

Botox covered by Insurance?

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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.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 104 reviews

Botox has been used for non-cosmetic uses for over three decades

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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.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 141 reviews

Botox for hemifacial spasm covered by insurance

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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???


Insurance may or may not cover botox for medical purposes

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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.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Yes it should be covered.

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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.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Insurance Coverage for Botox

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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.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.