Neuromodulators are a term to reflect injectables that reduce nerve activity. The most famous use is to relax the muscles that lead to wrinkles. There are several neuromodulators on the market now.

We use Botox (onabotulinum) and Xeomin (incaonabotulinum).

We specialize in both the therapeutic (medical) use and cosmetic use of Botox and Xeomin. Many of our patients receive a little bit of both.

We focus on these agents as part of a thorough treatment for the brain-body connection, not as part of a comprehensive aesthetic treatment, so we work differently than an aesthetic practice. Below are some important things to note:

Neuromodulators are covered under insurance plans for FDA-approved therapeutic procedures:

chronic migraines (headaches occurring more than 15 days per month with at least 8 days consisting of migraine)

cervical dystonia (and often other dystonia conditions)

spasticity from spinal cord or brain injuries (including cerebral palsy)

overactive sweating of the armpits

When these agents are covered under an insurance plan, there are two components—the cost of the medication and the cost of the procedure to inject the medication which is called “chemodenervation.”

For these covered uses, Botox and Xeomin can be dispensed by the medical practice (typically under the medical benefit of an insurance plan) or by a specialty pharmacy (typically under the pharmacy benefit of an insurance plan). With our practice structure, using medical benefits will have a co-insurance (typically reimbursing 50-80% of the total charge) and using pharmacy benefits will have a specialty pharmacy co-pay (just like other medications).

Obtaining a prior authorization for neuromodulators and chemodenervation takes hours of telephone calls, letters, and work with insurance companies. They do NOT make it easy. For medical use for other conditions (TMJ disorders, myofascial trigger points, neuropathic pain), it is typically not covered by insurance. No insurance companies cover cosmetic uses (wrinkle relaxation or other aesthetic uses).

Patient Savings Programs & Payments

Not only does health insurance help cover the cost of these medications and chemodenervation procedures, but having authorization also allows the drug maker to help cover some costs that the insurance company didn’t fully cover. Both Abbvie (makers of Botox) and Merz (makers of Xeomin) have patient savings programs that are quite generous and can provide an additional reimbursement up to $1300 for each procedure! We help all patients with insurance approval sign up for Patient Savings Programs. For these covered conditions, the combination of health insurance reimbursement and Patient Savings Programs make these treatments affordable or even no-cost!

We require payment before or at the time of service for all procedures. Because of the high upfront costs for neuromodulator treatments, we suggest signing up with our partners Advance Care Credit or Klarno. Advance Care Credit offers 0% interest credit cards (no annual fee and no cost to sign-up) and we suggest this route for patients who are going through the insurance system to await reimbursement. For patients receiving neuromodulators WITHOUT health insurance (non-covered conditions or cosmetics use), we can split the payment over 2 months or offer Klarno to create a brief payment plan over 4 payments.

Don’t Stress. We help you each step of the way!

Using Health Insurance

BBHA offers two routes for neuromodulation treatments using health insurance:

1. Medical Benefits - If you want to use the medical benefits of your health insurance for a therapeutic neuromodulator (typically Botox), you must have a diagnosis of chronic migraine, cervical dystonia, spasticity for spinal cord or brain injuries, or overactive sweating. In addition, having prior authorization from the insurance company opens up Patient Savings Programs from the drug manufacturer. In these situations, the drug company will reimburse you again for under-reimbursement from your insurance, and this comes even after the amount is applied to your insurance deductible. We help all patients receiving therapeutic neuromodulators sign up for these programs.

2. Pharmacy Benefits - For the same covered uses as Medical Benefits (see above). With this route, the insurance authorization requires that the neuromodulator be dispensed from a specialty pharmacy. This will be delivered to your home, and you will be responsible for storing it until the date of your procedure. You bring your neuromodulator to your appointment. This will be used only for your use, and any remaining amount will be thrown away. This is a requirement of the insurance companies. Patient Savings Programs can also be applied to the specialty pharmacy to reduce your co-pay. This amount can come to you as a reimbursement or go directly to the specialty pharmacy. We would collect the fee for chemodenervation on the day of the procedure.

   Not Using Health Insurance

   Many non-covered conditions can improve with neuromodulators:

   Medical conditions for which they can be very helpful:

   TMJ dysfunction (chronic jaw pain) and Bruxism (teeth grinding)

   Myofascial trigger points (such as neck, rotator cuff, back, and abdominal wall)

   Thoracic Outlet Syndrome

   Neuropathic pain

   Hyperhidrosis outside of the axilla (like recurrent acne or excessive sweating of palms/soles)

   and more

   We also treat cosmetic conditions; none of these are covered by insurance, even though they are FDA-approved. Our style is to relax the tight muscles and recover the skin with high-quality skin care. We don’t provide dermal fillers or other cosmetic procedures. Conditions we treat with neurotoxin include

   Frown Lines or “Angry 11s” (glabellar complex rhytids)

   Crows Feet (orbicularis oculi rhytids)

   Forehead wrinkles (glabellar rhyditds)

   Bunny lines (nasalis rhytids)

   Downward-turned smiles or nose

   Brow lifts

   Jaw slimming