Help with External Appeal for Botox

[Riva]

So not surprisingly I was denied for Botox by my insurance company. We were told the next step is to file an external appeal. Has anyone filed an external appeal, does anyone anyone have any tips, information, etc. Should we include all of my procedures, doctors visits, treatments and medications. My doctor has provided me with some recent research to use as part of my appeal, but any help, insight, tips would be greatly appreciated. If anyone has any recent examples of successful external appeals that they would be willing to share is also appreciated.

Thank you all!

[Patty]

For what its worth I paid $1300 on Botox and it did nothing. Doc told me 85% get better with this treatment. I wish you luck.

[Riva]

Thank you so much for taking the time to reply. It's so hard to know what to do. I hope you have found some treatment that offers relief. Hugs and prayers.

[Violet M]

When I had my appeal the independent reviewer agreed that having the TIR approach to surgery from Dr. Bautrant sounded like it was the right treatment for me, but then proceeded to deny the appeal because there was not sufficient peer-reviewed literature supporting the TIR approach to surgery. So, I can't say for sure what your reviewers are going to be looking for but I am guessing that peer-reviewed literature that supports Botox for chronic pelvic pain/pudendal neuralgia is probably the most important information you can provide in your appeal. The larger the study with the most subjects in it the better, and also if there are any randomized controlled studies it would be a plus, that is, of course, if they show positive results from Botox.
Here is one we have on our website but you can look in pubmed for more.
http://www.pudendalhope.info/sites/defa ... Gajraj.pdf

Personally, I never tried Botox, partly because my gyn said it might provide tempraroy relief but would not be a long-term solution. However, I think with PN even temporary relief can be worth it.

Violet