When Elizabeth Roberts-Zibbel was 39, the headaches she’d had off and on since childhood became chronic. Her usual medications couldn’t touch this daily pain. Desperate for relief, she and her family doctor began to discuss a new treatment: botulinum toxin.
You may know this drug by the name Botox, Dysport, Mybloc, or Xeomin. It’s the same injectable medication that keeps celebrities wrinkle-free.
But Roberts-Zibbel soon learned that her insurance company wouldn’t cover the cost of the injections.
“I called my insurance, and they gave me the runaround,” she says.
Her experience is not uncommon. Many people with migraine face hurdles in getting insurance approval for Botox or similar medications.
But as Roberts-Zibbel soon found out, there are a few ways to boost your chances of getting the green light you need.
Try Other Treatments First
Most insurance companies say you need to try other pain relief options before they’ll approve Botox or similar medications, says Kiran Rajneesh MD, director of the neurological pain division at The Ohio State University Wexner Medical Center.
These options include:
- Lifestyle changes such as quitting smoking, reducing caffeine, and eliminating problem foods.
- Medicines that halt migraine pain, including aspirin, ibuprofen, or triptans such as rizatriptan and sumatriptan.
- Medicines you take daily to prevent migraines, including beta-blockers, tricyclic antidepressants, or antiseizure medications.
It usually takes trying at least two different types of migraine medications before insurance will OK Botox, Rajneesh says.
See the Right Doc
Make sure you’ve locked in a neurologist or other headache specialist if you want to try Botox or similar meds for your migraine. Rajneesh says insurers may be more likely to cover the treatment if you’re getting it from a neurologist.
Roberts-Zibbel clued in to this tactic through calls to her insurance company. She made an appointment with a neurologist, and eventually her insurance approved three rounds of Botox.
One possible snag is the wait time.
“Nationally there’s a shortage of neurologists, and the wait time to see a neurologist is pretty long,” Rajneesh explains.
His advice: Start with your primary care doctor and treatments like lifestyle changes and triptans while waiting for a neurology appointment.
Keep a Headache Diary
Come prepared with all the deets for your doctor’s visit. This might help if you would benefit from Botox and similar medicines.
Rajneesh recommends printing out a blank calendar page where you record daily information about your migraines, such as:
- How many days a month do you get them?
- How long do they last?
- Do you see an aura?
- Are there any factors that trigger your migraines, like lack of sleep?
Bring Your Records
Your doc needs to know which treatments you’ve already tried so they can see the whole picture of your treatment history.
“A lot of times patients will tell me, ‘I’ve tried medications,’ but they can’t name the medications,” Rajneesh says.
“If I know what you’ve tried, and I see you’ve tried them for at least 2 months, that might give us a shortcut to move to the therapies that might help you get rid of your headaches.”
If you’ve had a CT scan or MRI of your brain, bring those along, too. Rajneesh also recommends letting your doctor know about any alternative therapies you’ve tried, such as physical therapy, massage, or acupuncture.
Ask an Expert to Weigh In
If you’re hearing “no” from your insurance company about this type of med, ask your neurologist if they’d be willing to call your insurer on your behalf.
Some insurers allow doctors to request a case review by a peer doctor. Usually this process happens over the phone.
Your doctor might also write an appeal letter explaining your health history.
If you’re feeling daunted by the authorization process for Botox and similar medications, take a breath, take it a step at a time, and turn to the experts.
“Don’t feel overwhelmed,” Rajneesh says. “Medical professionals are here to help you. That’s the first step: seeing one of us so we can get the process started and help you through it.”