Hi, there,This can be a tricky issue if you were not recently covered by health insurance. Any health insurance carrier you pick up may claim that your SD is a pre-existing condition. Overall, if it is determined to be a pre-existing condition you may not receive treatment for it under that insurance for anywhere from 6-12 months. This only applies to people who were not previously covered by another plan (i.e., if I were to switch jobs and health insurance right now, since I already have health insurance, any conditions I'm being treated for are covered).
Additionally, depending on the state in which you live and whether they have community rating and/or guaranteed issue laws (i.e., anyone who applies for health insurance is automatically accepted - New York has this law) you may have a rough time acquiring coverage if you have any medical conditions. And putting false information on an application can also run you into trouble.
If, however, by chance you are trying to get onto a spouse's policy and he/she works for a huge company, sometimes these restrictions about pre-existing conditions and exhorbitant costs won't apply.
As for coverage itself, botox is generally billed in 3-4 components:
1) The cost of the Botox itself: either by unit or for a whole vial ($100-$700)
2) The EMG
3) The "nerve surgery" or nerve block or chemodenervation of laryngeal muscle, injection, etc.
...and then possibly "durable medical equipment" which would be the cost for the EMG materials used. And in some rare instances, a laryngoscopy may be part of the procedure and that's also billed separately (but sometimes bundled w/ other services by insurance companies).
It's definitely not just "part of the regular visit."
The cost of Botox for SD can vary dramatically... anywhere from $700-$2500 depending on your MD, if it's in a hospital setting, unilateral v. bilateral injections, etc. Of course, most health insurance companies only pay a fraction of this and if the MD is on your plan it's accepted as full payment.
Co-payments, etc. will depend on your plan. If I see an in-network MD, my co-payment is $20. If I go out of network, there is a $500 deductible and then I'm also responsible for 20% of the bill. And in the case of going out of network, while some doctors will accept the insurance "rate" as full payment, they are not obligated to do so. So if the cost is $2500, your insurer pays $700... you are responsible for the rest. Bottom line is it makes more sense to see a physician on your plan.
Also, you need comprehensive health insurance that covers office visits and specialist visits. Treatment for SD would not be covered by what is commonly referred to as "major medical" insurance.
If you're trying to get coverage through a state or federal program, all these restrictions may not always apply.
Hope that's not too confusing. Sometimes too much information can be overwhelming but I know a lot about the industry so let me know if you have any questions.
Last... there are some MDs who will charge a flat/reduced fee to uninsured patients for Botox.
Good luck!
Laurie
