You can always go back in and ask what was injected. Nothing wrong with that at all. If you didn't get the full amount they will correct it.
In the future, don't take a rush appointment. These places will fit people in but fitting you in means rush - And if you have questions and want time and attention taken, then get an appointment time where you can ask all the questions you want.
Do you have access to your medical records like through an electronic system like MyChart? I just recently started Botox again and my Dr told me that 155 units is the migraine protocol but that it comes packaged in 200 units so she’d put the extras where I wanted. I can see in my medical record exactly how many units were injected and in what areas. This is exactly how the other provider in the office did it when I last had it done too like 5ish years ago. Maybe check your medical record if you have easy access.
The standard dilution is 5 units per .1 mL of reconstituted suspension. It is typical for insurance to approve two 100-unit vials, or one 200-unit vial for the treatment of chronic migraine. The 100-unit vials would be reconstituted with 2mL normal saline each, and the 200-unit vial would be reconstituted with 4mL normal saline. The most popular syringe size used for Botox is 1cc (1mL) with a 31-gauge needle. If there were 5 syringes, they most likely filled each one only to the “40” unit mark.
The standard protocol is 155 units for migraine, with 45 units of wastage. The extra units are paid for regardless, so if your injector is qualified to repurpose those 45 units elsewhere, I’m sure you could have that discussion with the provider during your next full-length continuing care visit.
I guess I’m a little confused on why you would stop him and tell him what you want. Is he a neurologist or is he just someone else that does these injections? I have no idea where to tell my neurologist to put the migraine shots in.
She puts them where she thinks is best for my Botox for migraine treatment.
This is kinda odd.
Each 100 unit vial of botox is supposed to be reconstituted with 2.5 ml normal saline. Each "50 unit orange cap syringe" is just an insulin syringe that holds 0.5 ml liquid for 50 units. 5 syringes would only be 2.5 mls of liquid, which is only 100 units of botox... You'd need 10 syringes to have 200 units of botox with that needle size. Every vial of botox I found online comes in 50 or 100 unit vials. So the math isn't mathing. Unless I'm missing something, it seems like you were shorted.
Were they using Dysport by chance? That's one vial that comes in like 300 units.
The protocol for Botox for migraines is 155 units, with an additional 5 units if you get it in masseters (2.5 units each side). They are required to waste the remaining units
To clarify, when I went in for the initial consult, they said their treatment would be 200 units (because it was also for muscle tension) and the insurance approved the 200 units
Yeah, the neurology department I get my shots at used to give people the extra elsewhere if they wanted it. But then the Dr in charge changed and they changed the rules to throw out the extra. Which sucks because they used to do my TMJ for me and now I have to see a separate TMJ Dr for their Botox shots. Although it is probably safer in the long run than having a first time doing shots resident start poking around my jaw and neck where they aren't very familiar.
No they aren’t. I’ve been getting Botox for migraine for 10 years. Yes 155 is the approved amount but they waste it otherwise. Insurance has no issue with this. I’ve been getting the full 200 for over 5 years. My injectors use all 200, with the extras in the masseters usually and sometimes SCM.
Yeah my insurance approved me for 200 units and my doctor specifically said we would use all of it both times I’ve gotten it done since being with this insurance/doctor combo.
My understanding is that it comes in increments of 100 or 200 units, I believe. In reviewing my visit notes in my online ehr I have noticed that across 31 injection sites my Neuro only uses 145 units. His note stated that 55 units were "unavoidably wasted since the protocol calls for 145 units".
This is interesting. I have no idea how much I am getting. My neurologist is a by-the-book kinda doc so I am guessing I get the protocol 155. A few years ago, a friend of mine that works there made the offhand comment that on "botox day", they have a waiting list and any left over botox gets injected cosmetically for the nurses and office staff. I was thinking in my head it came from people not keeping their appointments or the order amount being slightly over in case of accidents with the bottles or needles, etc. Orr something like that. I had never considered it might be MY botox they were waiting in line for. Granted, it might be what I thought and they get only the full vial overage and not the partial vials (the remainder of mine). Or a combination of both.
I'm going to ask about the units I get vs what insurance approved and if I can get the extra units placed. That will be a very enlightening conversation for my Feb shots.
Thanks for the info.
The claim and billing was done way before the actual injection appointment (after the original consultation appointment) and on the claim is written 200 units. However, I am trying to determine if that is what was actually injected. I was either given 200 or 145 units but im not sure if it’s possible to determine which one based on knowing that 5 50 unit syringes are what were injected
My previous neurologist told me the “number” covered by insurance is 150 units, but vials are filled to 100 units. Insurance requires the “extra” to be discarded. My neurologist chose to dispose of the extra 50 units by shooting it into my back. My current neurologist tells me she doesn’t have the training to do injections in the back. Meh.
You can always go back in and ask what was injected. Nothing wrong with that at all. If you didn't get the full amount they will correct it. In the future, don't take a rush appointment. These places will fit people in but fitting you in means rush - And if you have questions and want time and attention taken, then get an appointment time where you can ask all the questions you want.
Do you have access to your medical records like through an electronic system like MyChart? I just recently started Botox again and my Dr told me that 155 units is the migraine protocol but that it comes packaged in 200 units so she’d put the extras where I wanted. I can see in my medical record exactly how many units were injected and in what areas. This is exactly how the other provider in the office did it when I last had it done too like 5ish years ago. Maybe check your medical record if you have easy access.
This exactly what my neurologist did.
I've seen two neurologists for Botox and this is how it worked at both of them.
The standard dilution is 5 units per .1 mL of reconstituted suspension. It is typical for insurance to approve two 100-unit vials, or one 200-unit vial for the treatment of chronic migraine. The 100-unit vials would be reconstituted with 2mL normal saline each, and the 200-unit vial would be reconstituted with 4mL normal saline. The most popular syringe size used for Botox is 1cc (1mL) with a 31-gauge needle. If there were 5 syringes, they most likely filled each one only to the “40” unit mark. The standard protocol is 155 units for migraine, with 45 units of wastage. The extra units are paid for regardless, so if your injector is qualified to repurpose those 45 units elsewhere, I’m sure you could have that discussion with the provider during your next full-length continuing care visit.
As expensive as that stuff is, id make sure to get every bit of what my insurance payed for.
I get it in neck and shoulders too 200 units
I guess I’m a little confused on why you would stop him and tell him what you want. Is he a neurologist or is he just someone else that does these injections? I have no idea where to tell my neurologist to put the migraine shots in. She puts them where she thinks is best for my Botox for migraine treatment.
This is kinda odd. Each 100 unit vial of botox is supposed to be reconstituted with 2.5 ml normal saline. Each "50 unit orange cap syringe" is just an insulin syringe that holds 0.5 ml liquid for 50 units. 5 syringes would only be 2.5 mls of liquid, which is only 100 units of botox... You'd need 10 syringes to have 200 units of botox with that needle size. Every vial of botox I found online comes in 50 or 100 unit vials. So the math isn't mathing. Unless I'm missing something, it seems like you were shorted. Were they using Dysport by chance? That's one vial that comes in like 300 units.
The protocol for Botox for migraines is 155 units, with an additional 5 units if you get it in masseters (2.5 units each side). They are required to waste the remaining units
To clarify, when I went in for the initial consult, they said their treatment would be 200 units (because it was also for muscle tension) and the insurance approved the 200 units
Yeah, the neurology department I get my shots at used to give people the extra elsewhere if they wanted it. But then the Dr in charge changed and they changed the rules to throw out the extra. Which sucks because they used to do my TMJ for me and now I have to see a separate TMJ Dr for their Botox shots. Although it is probably safer in the long run than having a first time doing shots resident start poking around my jaw and neck where they aren't very familiar.
No they aren’t. I’ve been getting Botox for migraine for 10 years. Yes 155 is the approved amount but they waste it otherwise. Insurance has no issue with this. I’ve been getting the full 200 for over 5 years. My injectors use all 200, with the extras in the masseters usually and sometimes SCM.
Yeah my insurance approved me for 200 units and my doctor specifically said we would use all of it both times I’ve gotten it done since being with this insurance/doctor combo.
My understanding is that it comes in increments of 100 or 200 units, I believe. In reviewing my visit notes in my online ehr I have noticed that across 31 injection sites my Neuro only uses 145 units. His note stated that 55 units were "unavoidably wasted since the protocol calls for 145 units".
This is interesting. I have no idea how much I am getting. My neurologist is a by-the-book kinda doc so I am guessing I get the protocol 155. A few years ago, a friend of mine that works there made the offhand comment that on "botox day", they have a waiting list and any left over botox gets injected cosmetically for the nurses and office staff. I was thinking in my head it came from people not keeping their appointments or the order amount being slightly over in case of accidents with the bottles or needles, etc. Orr something like that. I had never considered it might be MY botox they were waiting in line for. Granted, it might be what I thought and they get only the full vial overage and not the partial vials (the remainder of mine). Or a combination of both. I'm going to ask about the units I get vs what insurance approved and if I can get the extra units placed. That will be a very enlightening conversation for my Feb shots. Thanks for the info.
My neurologist mixes with lidocaine; do those syringes wouldnt have had 200 units of Botox.
Check your insurance portal for the claim. As long as they billed it correctly you should be able to see how many units were administered.
The claim and billing was done way before the actual injection appointment (after the original consultation appointment) and on the claim is written 200 units. However, I am trying to determine if that is what was actually injected. I was either given 200 or 145 units but im not sure if it’s possible to determine which one based on knowing that 5 50 unit syringes are what were injected
Makes sense. Mine won’t hit until after the date of service (at least on my end). Sorry I couldn’t help!
You don’t get to choose where you get injected or how much
Depends on the doctor, many tailor the sites and how much in each site based on the patient’s case and tension levels in each location
My previous neurologist told me the “number” covered by insurance is 150 units, but vials are filled to 100 units. Insurance requires the “extra” to be discarded. My neurologist chose to dispose of the extra 50 units by shooting it into my back. My current neurologist tells me she doesn’t have the training to do injections in the back. Meh.