Blepharospasm Bulletin Board

Botox reimbursement
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Posted by: Don Peaslee
02/01/2004, 16:13:40


Many of you are aware that some patients have recently been having difficulty getting proper reimbursments for their Botox injections from Medicare or other insurance carriers. We have heard that some doctors have stopped supplying the Botox and now require the patients to pick up their own Botox from the pharmacy. Have you experienced this? Has it made a difference as to how your insurance carrier covers the cost? We need to collect as many facts as we can about these situations in order to find out exactly what is happening and where it is happening. Only with solid information can we approach Allergan, Medicare, Blue Cross and other insurance carriers to try to get any misunderstandings straightened out.

If you do have personal experience that you think will help us, please respond to this bulletin board message. Or, if you prefer to be more private, please e-mail the BEBRF at BEBRF@blepharospasm.org. Thanks for your help.

Don Peaslee, BEBRF Vice President




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Re: Botox reimbursement
Re: Botox reimbursement -- Don Peaslee Top of thread Archive
Posted by: Virginia in AL
02/01/2004, 16:32:34


I haven't had any recent problems, but I do know from past experience that my insurance will not pay if I am required to pick up the botox myself and take it to the doctor.

Virginia in AL (Blue Cross Blue Shield of Alabama)




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Re: Botox reimbursement
Re: Botox reimbursement -- Don Peaslee Top of thread Archive
Posted by: Debbie
02/01/2004, 16:46:32


Blue Cross Blue Shield pays for mine. I only pay $60 which is the percentage I pay with my policy.
Debbie



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Re: Botox reimbursement
Re: Re: Botox reimbursement -- Debbie Top of thread Archive
Posted by: Don Peaslee
02/02/2004, 09:28:58


Debbie,
Do you pick up your Botox from the pharmacy and take it to your doctor for the injections?
Don



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Re: Botox reimbursement/for Don
Re: Re: Botox reimbursement -- Don Peaslee Top of thread Archive
Posted by: Debbie
02/02/2004, 14:32:46


Don,
No, my opthalmologist has the Botox in his office. However, in addition to BEB patients, tear duct surgery, etc. he also uses Botox for cosmetic purposes....so I don't know if that makes a difference or not. Anyway, I haven't had any problems with Blue Cross so far.
Debbie



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Insurance ...
Re: Botox reimbursement -- Don Peaslee Top of thread Archive
Posted by: Moderator-JB
02/02/2004, 17:54:09


Hi Don,

Regence Blue Shield, my carrier, did try this a while back with my coverage for Botox. They wanted me to pick up the 'prescription' at my pharmacy and take it to the physician's office. Had I done this, I would have to pay a very high price for it out of pocket. Most Medicare patients do not have coverage 'J' or one of the other few types which cover prescription costs. Too expensive.

Therein lies the problem. Botox is not a regular prescription. It is the subject/reason for the procedure (Chemical Deneveration). It can also be compared to the anesthetic used with surgery as a point of argument. You can't just pick it up at the corner drug store.

For those of you who do not know ...
Botox has special handling requirements, not to mention storage and thawing from it's shipped, freeze dried state. Certain techniques of injection are used to get you the best customized results. These vary greatly from person to person.

Think of it as 007's martini which was to be stirred, not shaken. The carrier for Botox needs to be rolled into it while thawing, not handled roughly or refrozen. Some doctors have been known to tell their patients that they can 'save' it for next time by freezing the remainder. Not possible. This is also not a subject you want to get me started on. Think insurance fraud.


Judy/WA State



Modified by Moderator-JB at Mon, Feb 02, 2004, 17:56:58

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Re: Insurance ...
Re: Insurance ... -- Moderator-JB Top of thread Archive
Posted by: Virginia in AL
02/02/2004, 20:19:51


I got injections at Emory (in Atlanta) once - they had previously required patients to bring their own Botox and most still did. It was strange to look around the waiting room and see people sitting there with coolers.

I guess I should add that, though BCBS AL doesn't allow me to pick up my own botox, I don't pay a cent for injections - they cover it all and as often as the doctor will allow.




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Re: Insurance ...
Re: Re: Insurance ... -- Virginia in AL Top of thread Archive
Posted by: Gayle
02/06/2004, 12:35:28


Virginia, where in AL are you? I am in Columbus, GA. I also had shots done at Emory. Which doctor did you see? I did not have to pick up my botox. They ordered it for me. I have also been to Birmingham (which I guess is what you mean by BCBS), and was well pleased with the doctor and the injections. I did not have to pay a cent, either. But the 3 hr. drive for my husband when I can get it from a local doctor, well he don't want to make the drive.

Gayle in GA on a cold, rainy day




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Re: Insurance ...
Re: Re: Insurance ... -- Gayle Top of thread Archive
Posted by: Virginia in AL
02/06/2004, 22:40:14


I live in Huntsville (North Alabama). I saw Dr. Watts and Dr. Evatt at Emory. Going to Atlanta was difficult for us, as Dr. Evatt only did injections in the mornings and we lose an hour because of the time zone change and it's a four hour drive for us anyway - so we had to get on the road way too early. I did not have to pick up my botox either, but that's the way they used to do it. BCBS is Blue Cross Blue Shield - I just got lazy with my typing.

I would love to be able to get injections locally, but Huntsville just doesn't have a doctor that I am willing to go to. The only ones who give injections here (that I know of) are plastic surgeons and I need a neurologist. I go to Birmingham - to UAB - for injections. In fact Dr. Watts (from Emory) is head of Neurology there now. It's a two hour-ish drive for us, but my daughter lives there and it's a chance to see her over lunch every couple of months. So far hubby is not complaining.

I think we've had the same kind of nasty stormy weather that you have had and I don't do well in that kind of weather either.

Sorry this is so long. Guess I got carried away. Hope to see you at the conference this summer.




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Re: Insurance ...
Re: Re: Insurance ... -- Gayle Top of thread Archive
Posted by: Amy
02/21/2004, 03:53:50


Gayle,
I saw your post and am also from Ga., Bainbridge to be exact. I also use UAB in Birmingham. I am new to the BB though I have been on the dystonia BB. I would like to hear about your experience. It is nice to hear from someone so close. Feel free to email me if you like.
Amy



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Re: Insurance ...
Re: Insurance ... -- Moderator-JB Top of thread Archive
Posted by: APhair
02/02/2004, 21:59:17


Hi Judy. I usually agree with you on things but on this one I have to differ. I picked up the medication regularly at the Pharmacy prior to my losing coverage for prescriptions once Medicare took over. It was a very simple process since the medication was given in what we in the business called a refrigerated container. It easily stayed frozen until I got to the Doctors office for the injections.

AS to Dons inquiry begarding pricing etc., you may remember that I did a presentation on this several years ago at a BEB international conference. I had collected quite a bit of data and it was interesting how there were so many variations depending upon insurance carriers and Country of origin. I had also at that time mentioned how I had gone from my doctor providing the botox and billing e through my insurance company and my having to pay the 20% co pay as I did for my visit. I switched Dr's and he would not provide it and low and behold, come to find out that my insurance company paid for the drug and I only had to pay a $2 copay. For years it had cost me almost $200 under the 20% method.

Now, since I am on Medicare, what happens is what I supected happens in many cases involving those who serve medicare patients. The doctor schedules me on a day when he does a lot of injections and I will leave it up to your imagination what he does with the excess left over from all those that only got 60 units. Am I complaining? Heck no as he is still able to give me my shots every quarter. ...Alan




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Re: Botox reimbursement
Re: Botox reimbursement -- Don Peaslee Top of thread Archive
Posted by: pdb
02/03/2004, 15:40:25


Last time I got my botox myself from a drug store in Manhattan, and took it directly to the Dr office, and was injected. Although we were trying new locations and dilutions to avoid ptosis, and that might have contributed, on this occasion I had zero beneficial effect. Any chance it was a dead vial? Certainly got no indication it was freezing cold when I picked it up.



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Re: Botox reimbursement
Re: Re: Botox reimbursement -- pdb Top of thread Archive
Posted by: Delaine Inman TN State Coordinator
02/04/2004, 11:00:44


Yes ........It should have been frozen and in an insulated package to keep it that way until the saline is added which thaws it prior to injection. When I got mine from the Vanderbilt pharmacy they handled it all the time and knew what to do. When I got it in Columbia I talked with the pharmacy and went over the handling & storage procedure when it was ordered. When I picked it up they got it from the freezer. The "in" basket had a note on the bag where to find the medication.



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Re: Botox reimbursement
Re: Re: Botox reimbursement -- Delaine Inman TN State Coordinator Top of thread Archive
Posted by: pdb
02/04/2004, 18:02:52


so it sounds like my last injection was less than useful because ofthe handling. Interesting/pain in the ....



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