BOTOX POLICIES
NEUROSCIENCE CONSULTANTS, PLC POLICIES FOR NEUROLOGICAL BOTOX TREATMENTS
BOTOX PREAUTHORIZATION
Step 1: Medical indication and documentation
If your medical diagnosis includes an FDA approved indication for Botox treatments, and your healthcare provider recommends Botox treatments, the necessary documentation will be entered into your electronic medical record. Typical medical conditions where Botox treatments are indicated and FDA approved include Chronic Migraine Syndrome, Cervical Dsytonia, Blepharospasm and Facial Spasm. Other neurological conditions where Botox might be helpful may not be FDA approved and are unlikely to be covered by your insurance. Even for medical conditions where Botox treatment is FDA approved; your insurance may not cover it due to their own internal policies. We cannot change that. NSC, PLC does not provide Botox treatments for cosmetic purposes and will not use any available Botox for cosmetic applications.
Step 2: Dealing with your insurance company
Our staff is highly experienced in Botox preauthorization, and we will use our best efforts to obtain the necessary preauthorization so that you may receive medically necessary Botox treatments. On average, it takes an hour or more of staff time to perform Botox preauthorization. We may need to escalate your case to an outside specialty preauthorization firm. We use NYXHealth, a highly reputable national leader in the preauthorization industry. If we need to escalate your case to NYXHealth, we will inform you and require from you a $25 fee to cover our costs. The preauthorization process typically
takes 2 to 4 weeks to complete. We cannot guarantee your insurance will authorize Botox treatments even when your condition is associated with an FDA approved indication for Botox treatment. Since we will use our best efforts on your behalf, we will not engage in any appeals process if your insurance will not cover the cost of your Botox. Preauthorization is usually necessary at the beginning of every new year and/or if your insurance changes during the year. Even with the same insurance policy, coverage may change from year to year. We cannot guarantee that if your insurance covered Botox this year, they will cover it next year.
Step 3: Dealing with your specialty pharmacy
In most cases, your insurance company contracts with a specialty pharmacy. We order your Botox from the specialty pharmacy. The specialty pharmacy supplies your Botox to our facility so that we can perform your treatment. We will ask you for the name and contact information of your specialty pharmacy. Without that information, we cannot order your Botox. Your specialty pharmacy will contact you directly so that you can pay the co pay for your Botox and authorize shipment to our facility. The specialty pharmacy WILL NOT ship your Botox to us unless you pay your co pay and authorize shipment. If your insurance does not cover the cost of your Botox, we will order it from our supplier subject your advance payment in full. Costs will vary depending on the amount of Botox we will need to order.
Step 4: Scheduling your treatment appointment
Your specialty pharmacy will ship your Botox to our facility where we will log it into our refrigerated storage equipment. Once we receive and log in your Botox, we will contact you to schedule your treatment appointment. We will offer you the next available treatment appointment. Botox migraine treatments are usually done every 90 days. We will not schedule a treatment appointment before we receive your Botox. There are no” emergency” treatment appointments.
Step 5: Professional Fees
NSC, PLC no longer accepts insurance payments for our professional services to perform your Botox treatment. We now administer Botox only on a fee for service basis. Professional fees must be paid at the front desk on the day of service, prior to receiving your treatment. We accept cash, check or credit cards.
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Botox Treatment for Migraine: $500 per treatment
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Botox Treatment for Facial Tics, Blepharospasm or Hemifacial spasm: $500 per treatment
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Botox Treatment for Cervical Dystonia without EMG guidance: $650 per treatment
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Botox Treatment for Cervical Dystonia with EMG Guidance: $1200 per treatment