The answer is that it depends on your insurance, and the reason for it's use (indication). Some insurance companies consider botox with this diagnosis as cosmetic or non-functional, and deny all coverage. Other companies may go the opposite direction and just assume coverage.
But most will look at the specific indication and/or require more information to determine that specific indication. That's because they want to ensure the reason for botox use is functional. Issues resulting from Bell's palsy such as eye protection, drooling, biting the lip are all functional problems. Therefore if your physician is clear in treatment for these issues, coverage is much more likely.
My suggestion to you is to start with a phone call to your insurance company benefits or customer service line. They should be able to tell you about coverage, level of coverage, or even a request to preauthorize your injections submitted by your surgeon. And please see a surgeon (plastic surgeon, facial plastic surgeon, or oculoplastic surgeon) for this type of care.
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.
Web reference:
https://www.edelsteincosmetic.com/
Botox can be covered under insurance in a few circumstances. Patients with temporary or permanent facial paralysis can sometimes get botox treatments through insurance. Treatment of synkinesis (abnormal and involuntary movements or twitches that can develop after recovery) or treatment of the nonaffected side (to promote better balance) can be done. Patients with hemifacial spasm and other facial tic disorders can also get the treatments covered.
The problem with insurance is that the raw product is somewhat expensive and it is sometimes very hard to get the therapy approved. I have also had circumstances where insurance denied payment after treatment, even when they had approved it pre-treatment. You need to be prepared to pay the full out of pocket cost for the treatment if that occurs and should ask ahead of time what that fee may be.
Best of luck
Each insurance company varies in its flexibility and ability to judge what is medically necessary. It would be perfectly valid for Botox to be covered for torticollis, muscle spasms, and other neuromuscular problems, but it is not a guarantee that the insurance company will do it.
Bells Palsy is usually caused by a viral attack on the facial nerve, with responding inflammation of the nerve, and weakening of the attached muscles on that side of the face. It can be very temporary, or linger longer. Botox is not actually used on THAT side...... but occcasionally on the OPPOSITE side, to soften the muscle action there and make the face appear more even.
Having the treamtent through a qualified and skilled neurologist may be more effective in getting insurance coverage, rather than a physician known to otherwise do only cosmetic treatments.
Great question but you would have to check with your insurance company for an explanation of benefits, especially in a questionable treatment regime.
From MIAMI Dr. B
