Insurance denial for botox

[HerMajesty]

Tracy,
I'll bet in community of Docs such as Hibner who are on the cutting edge of pelvic pain work, there probably IS some peer review literature supporting the use of pelvic floor botox; the problem is digging it up. I don't have any interaction with that office but if you get a chance to ask them to point you to any publications, that would be great. I can probably dig up the info myself if it come to that but I enjoy shortcuts! Which insurance plan do you have? Maybe I will shortcut by calling them and saying I heard they approve pelvic floor botox and would like to know on what basis.

[TracyB7777]

I work for a school district that is self-insured, Ameriben handles all the claims so they may be the one's to assist. They have a website: ameriben.com I heard St. Joe's will no longer bill insurance companies for the botox so I have to check with Hibner's office and see if I have to pay out of pocket and request reimbursement. I'll definitely ask if they can direct me to peer review literature for you.

[HerMajesty]

Thanks

[Quilter 2]

Good AM HM;
I fought UHC for 6 months for Botox. At first they gave me about the same answer you got. Drs Conway and Quesada wtoe letters for me. Also I faxed them 26, yes 26 pages, of info on Botox for PNE. I actually did it twice. I bascily bombarded them with paperwork. Some Dr., can't remember who but will try to find out, wrote an article about Botox for the Obturator Muscle. Ask Ali. I think he's the one that told me about the article.
I was finally allowed one shot. It was given to me in my buttocks. When I saw Dr. H, he just shook his head and said it needed to be done through the vagina. I don't know who is right, but it's something to look into if you finally get okayed.
My best;
Doreen

[HerMajesty]

Thanks Doreen, if you still have any of the info you faxed over, I would love to find a way to get a copy from you. Can you send me a PM if you still have the papers?
Ali, where are you? I'll PM if he doesn't see this. Still not sure what will happen with the peer-to-peer but if it comes down to an appeal from me, I will bombard them with everything at once

[RJR]

Perhaps this is what you are searching for?
Gajraj NM. Botulinum toxin a injection of the obturator internus muscle for chronic pelvic pain. J Pain 2000;6:333-337.
RR

[HerMajesty]

Perhaps this is what you are searching for?
Gajraj NM. Botulinum toxin a injection of the obturator internus muscle for chronic pelvic pain. J Pain 2000;6:333-337.
RR

Thanks, I found the abstract online and printed it. I need more backup as I am targeting the piriformis not OI but any botox to pelvic floor article certainly cannot hurt. The denial seems quite explicit in its wording though: They will want piriformis articles. When I get a chance I will search Dr. Filler's published material as he is very focued on the piriformis.

[Quilter 2]

HM;
I can't PM or get them. It has to do with the bot thing. Kris is on vaca so when he gets back we might be able to do something. But on another area I wrote, wrong or right, here is my e-mail rdinvt@sover.net. I kn ow we're not suppose to do this, but have no choice. RJR has the article, Thanks, RJR. it saved me looking for stuff, DOWNSTAIRS. Damn those stairs, they're killing me.
HM, give me a few days and I will try to see what I have down there. Having some real bad days at the moment. When Rod is home, I will send him up and down. Another thing, I had my PT write me something also.
Loretta Robertson, Dr. H's PT just might be able to send you in the right direction for info. I'm not sure how it works if you're not her patient but what the H, call the office and see if they will just give you an idea where to get info. Also, if you can find Ali, he's one of the best researcers I've seen. I bet he will have seen something on his quest. VTPNR or something like that does a lot of research also. His wife is a radiologist in Burlington VT so maybe he can help. When my PT that I haven't see for awhile gets back from vaca, I'll write her and see if she knows where to get some articles. I have dial-up so my looking up anything is a nightmare.
Feel free to send me your E and even though I'm no computer whiz, I'll try to send you whatever I find.
Drive the ins company NUTS with paperwork. It takes time, but they hate all that stuff coming into them on a weekly basis. Oh, what about your ins. commisoner in NV? Maybe you could call and see what they have to say. And, a senator or congress person.
Just a pile of ideas. Maybe just one will work for you.
Sincerely;Doreen

[TracyB7777]

Sigh, my insurance has no problem with botox they just don't feel the procedure is medically necessary. Just found out today. Now I have to go back to Hibner's office staff and see if they can convince the insurance company otherwise. I hate it that someone in an office who doesn't know me and has never examined me can decide if something is medically necessary or not. URGH!!!

[TracyB7777]

Ok, I completely lost it today!!! I called Hibner's office and they said the insurance is denying the entire botox procedure because it's "experimental". That's not what the insurance company told me yesterday!! I am so frustrated with getting the run around. I keep getting the same kid on the phone, who is new, and is learning about our insurance plan as I ask question URGH!!!! I can't seem to get any further either.

So with everyone's experience what do you think? Is this a block wall? I truly have never had issue's with insurance before and this is just unbelievable! I may have to cancel everything for next week. And of course, with the stress, the pain levels just keep increasing. Just want to cry, even though I know it won't help. Guess I'll go back to work instead. YOu know...put the fake smile on and tell everyone you are OK even though you want to SCREAM!!!