Migraine Botox Out-of-Pocket Planner

Estimate how much Botox for chronic migraine will cost you out of pocket after insurance. Enter the allowed amount, remaining deductible, and coinsurance rate, then layer in session frequency, copay cards, out-of-pocket maximums, or provider charges to see per-visit spending, annual cash requirements, plan payments, and any balance bill exposure.

Allowed charge negotiated with your insurer for one Botox injection visit.
Portion of your annual medical deductible still unpaid before the plan coinsurance kicks in.
Percent of the allowed amount you pay once the deductible is satisfied.
Most chronic migraine protocols require injections every 12 weeks (4 sessions annually).
Manufacturer assistance or bridge program applied to each visit. Defaults to $0 when blank.
Remaining headroom before your medical out-of-pocket maximum is met this year.
Total provider charge before network discounts. Defaults to the allowed amount when blank.

Healthcare cost planning aid — confirm coverage policies, medical necessity requirements, and copay assistance eligibility with your insurer and neurologist before scheduling treatment.

Examples

  • $640 allowed, $1,200 deductible left, 20% coinsurance, 4 sessions, $125 copay card, $780 billed ⇒ Per session out-of-pocket after assistance: $383.00 USD. Annual patient cost: $1,532.00 USD across 4 sessions. Plan payments toward allowed amounts: $1,088.00 USD. Uncovered provider balance billed directly: $560.00 USD. Deductible remaining after treatment: $0.00 USD.
  • $520 allowed, $0 deductible, 10% coinsurance, 6 sessions, no copay card, $1,500 OOP cap ⇒ Per session out-of-pocket after assistance: $52.00 USD. Annual patient cost: $312.00 USD across 6 sessions. Plan payments toward allowed amounts: $2,808.00 USD. Uncovered provider balance billed directly: $0.00 USD. Deductible remaining after treatment: $0.00 USD.

FAQ

How do I model mixed in-network and out-of-network visits?

Run the calculator separately for each provider. Use the allowed amount for in-network visits and the billed charge for out-of-network visits to see the balance you may owe.

Can I include facility fees or anesthesia?

Yes. Add those amounts to the provider charge field so uncovered balances capture surgical center or anesthesiologist bills that sit outside the allowed Botox rate.

What if my plan pays a portion of the deductible via HSA contributions?

Subtract the employer HSA contribution from the deductible remaining field so the calculator only reflects dollars you must supply from cash flow.

Does this model infusion center copays?

Include per-visit infusion copays within the copay card field as a negative value or add them to the provider charge if they are always billed on top of the allowed amount.

Additional Information

  • Deductible dollars are applied first each session until you meet the remaining balance, then coinsurance governs the rest of the allowed charge.
  • Manufacturer copay support reduces your share but cannot drive a visit below $0 — any excess simply expires.
  • Out-of-pocket maximums cap patient spending; once triggered the plan absorbs the remaining allowed amounts for the year.
  • Uncovered balance represents the gap between provider charges and allowed amounts when the practice is out of network or bills above contract rates.

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