Why Would Botox Therapy Treatment Cost $4090.00 for a Single Treatment That Took 15 Minutes?

I am a dermatologist and my husband is a headache specialist so I think that I can answer this fairly reasonably. Dermatologists use lower doses of Botox when using it for cosmetic purposes. The average that I use for a woman's face is 40-50 units. Botox prices range from $10-$15 a unit ,varying in areas of the USA. When headaches are treated most neurologist use  about 150 units. Insurance reimburses the cost of most of the Botox(some pay less per unit than it costs the doctor to buy) and usually an injection fee that is a couple to a few hundred dollars at most(insurance here pays $1,000). So, we are talking about something in the one thousands range not $4,090. If you were charged cosmetic fees for 150 units at most should be 2,250. If insurance paid some and you could be balance billed, $800 is not out of range but the original charge makes no sense. Call and ask about it. 

I am sorry to hear about your experience and I understand your frustration with the complex and seemingly illogical costs associated with insurance covered medical treatment. My family member had similar experience like this so even physicians are not immune. The best thing to do it get an itemized bill so you can clearly see where the charges are coming from. This give you something to work with and hopefully can get your charge down to a more reasonable level. With my private pay patients, Botox are charged between $10 to $20 per unit depending on the amount and location of usage. Unless you are billed for other services or used more than 200 units of Botox, I can certainly see why you feel the charges are excessive. In any case, it's perfectly reasonable to discuss your charges with your physician.

Best Wishes, 

I have several patients who stopped going to neurologists for their migraine injections and started coming to see me, for the reason you are stating (though $4090 is grossly over the amount I've ever seen unless additional tests were also done that day?). Most cosmetic physicians don't deal with insurance for Botox anymore because it's such a fight to get any type of reimbursement, and usually after all is said and done, you end up recouping less than the cost you put out, so it's a tough battle, for physicians and patients. You should ask the physician's office for an itemized statement, as well as your insurance company for a copy of your EOB. This will help you determine what was charged and why. My other guess is that perhaps since this was a procedure, your higher amount due is part of your deductible, which the physician has no choice but to charge you as part of their contract with each associated insurance. Some people have zero deductibles for office visits, but high deductibles when it comes to procedures. Just a thought.

There are many factors that determine the fee that physicians bill to insurance, including location of the procedure (surgery center, outpatient office, hospital), expected reimbursement from the insurance company, the physician's fee for performing the procedure, and the medication cost (which can be significant in the doses that are required for migraines). The only way to sort through these numbers is to have the physician's office give a breakdown of their charges. I would ask how other patients fund the injections as well. Since the injections need to be repeated, I would certainly sort it out before proceeding with a second treatment. Finally, the companies that make Botox (i.e. Allergan) often have patient assistance programs that can help significantly. Good luck!

The cost paid indeed seems excessive. Botox can be a very effective treatment for many migraine sufferers, reducing the intensity or frequency of migraines, and reducing hospital visits. Most people receiving migraine treatments will receive 100-150 units of Botox, and the cost is typically between $10-$15 per unit.

We never do it. We found that billing insurance for Botox barely covers the cost of the Botox plus a low level office visit. After all of the machinations to get the insurance company to pay, it, regrettably, is a losing proposition in Northern California. The billing physician probably billed very high to get fair compensation after the fee was reduced by the insurance company. Now he looks bad to the patient.

Dear Gary,

I sympathizes with your frustrations about the high cost of this treatment.  You definitely need to discuss this bill with your wife's doctor and/or insurance.  As you may know, Botox is purchased by doctors and typically sold based on the quantity (in this case "units") of the product.  Depending on the complexity of the problem being treated and other local market/industry factors, the cost can range between $10 to $20 per unit.  I treat many patients who have migraine as well as cosmetic issues and I rarely use more than 100 units per treatment.  If your wife required over 200 units of the medication, it is remotely conceivable that the charges may approach $4000.   If this was an initial consultation, the doctor may have also billed for other charges such as physician evaluation or examination charges.  You should have them itemize the billing for you; but I do agree that this seems very high.  The good news for your wife is that Botox is a highly effective, safe, and efficient treatment for this debilitating condition.  Best regards. DY

Botox is generally charged by the unit. The cost to the Physician is about $6 per unit, and sold to the patient at $10-15 per unit. Since I do not perform Botox for insurance purposes, I cannot comment on your Phyician's charges. $4090 for a Botox treatment does seem excessive. 

Without knowing what your itemized charges were, it's very difficult to answer your questions. While the treatment doesn't take very long, cost is not dependent upon time, but number of units. In your case, it sounds like there may be an issue with medical versus cosmetic use and what they're willing to pay for.

   Some doctors who inject Botox for migraines lose money on the injections, and there are very few who inject with payment from insurance.   I would suspect that the insurance barely covered the cost of the Botox no matter what the initial bill appeared to be.