Jen​nifer Miller MD 

​​​Call 518-264-3600

Dr Miller provides Botox injections for multiple diagnoses including spasticity (tightened muscles) related to stroke, brain injury, spinal cord injury, dystonia, cerebral palsy, multiple sclerosis and other neurologic disorders as well as hyperhidrosis (sweating) in amputee patients. 

The term 'Botox' is used throughout the website since it is often most familiar to patients, however, Dr Miller uses multiple botulinum toxins or chemodenervation agents in practice. During your appointment the most appropriate medication for your clinical situation will be discussed and determined. 

For possible treatment, please schedule an appointment. 

BOTOX LETTER

The following information is for patients who have seen Dr Miller and had treatment recommended:

Dr Miller is recommending treatment with BOTOX (botulinum toxin injections) for your specific medical condition. This letter is designed to provide you with important information regarding the treatment plan that you and your provider discussed. Our goal is to make sure you fully understand how this treatment may benefit your medical condition, and to help you understand how you can play an active role in your treatment decisions and ongoing care.  

Typical Treatment Plan

First Injection: Expect appointment time to be 30 minutes.  You may use ice pack for injection sites. If you are late, your injection will need to be rescheduled.
Follow-up appointment: You will have a follow-up appointment 4-6 weeks after your first injection. These appointments are recommended because it is important to see how the treatment is working for you.
Additional Injections: Your injection appointments will be scheduled every 3-4 months. It can sometimes take 2-3 injection appointments to receive maximum benefit or optimize the dose for your treatment.

How We Work With Your Health Plan

Prior to treating you with BOTOX, we must first receive approval from your insurance company. We will submit information to your insurance company that was gathered during your visit with the provider. As part of that process, we confirm plan coverage and benefits including co-pays, co-insurance, and deductible amounts. This can take 2 to 4 weeks depending on your health plan. Some plans require additional information from the physician and may require separate approvals for the injection procedure and the drug.

In rare cases, we will need to obtain Botox medication through a specialty pharmacy. If this is required, you will be contacted directly by the specialty pharmacy (Please answer when they call it’s usually a 1-800# or an unknown number) to provide permission for the drug to be delivered to the practice for your treatment, and for the pharmacy to collect any co-payment that is required for the drug.

 

Your Financial Responsibility

For certain types of insurance, assistance may be available to help you with your co-pay amounts for BOTOX. There is a separate BOTOX savings card available through our office. You can register online and will need to submit your EOB (Explanation of Benefits) which you will receive from your insurance company. Please feel free to call the office if you have any questions.

 

How You Can Help

You play an important role in your treatment. Below is a list of things you can do to be an active participant in your treatment plan:

Provide updated contact information.
Notify us immediately of any changes in your insurance.
Keep scheduled appointments and notify us as soon as possible if you need to change an appointment (24 hours or you will be charged a fee).
Respond promptly to requests from the practice or others such as specialty pharmacy, to avoid treatment delays

 

Other Medical Considerations

If you are on the blood thinner Coumadin (warfarin), Dr Miller will perform injections if your INR level is within desired treatment range (2.0-3.0 but not above). INR should be checked 2-3 days prior to injection, if level >3.0 please postpone your appointment and contact the doctor prescribing your Coumadin for a likely dose adjustment.


If you have any infection such as cellulitis (skin infection), sinus infection, pneumonia, urinary tract infection or other illness for which another doctor started you on antibiotics, please postpone your Botox injection until after 10 days off antibiotics. If you are unsure whether you are in this situation, please call the office before your appointment.

 

Physical Therapy

If you are already working with a physical therapist, there are no restrictions on continuing PT except treatment the same day as injection should either be avoided or focused on areas other than the muscles treated.

If you are beginning PT for the first time after Botox, try to schedule initial evaluation 10-14 days after injection so your physical therapist may note Botox effects.

 

 

Frequently Asked Questions


What are the primary side effects of Botox?

Most patients tolerate Botox without any side effects though it is possible to have post-injection soreness, bruising or bleeding. Ice or Tylenol can be used for injection soreness. It is possible to develop an antibody response with repeated use (causing injections to stop working). Very rare side effects include flu-like illness, nausea, diarrhea, weakness, difficulty urinating, drowsiness, or allergic response.

 


How long does Botox last? How often will treatments occur?

Botox typically lasts for 3-4 months. A few patients experience longer lasting effects for 6-9 months. When the dose lasts less than 3 months, it can be increased the following treatment to try to improve duration.


 

Will I notice the effects right away?

Botox begins to take effect in 3-5 days, sometimes 7-10. Noticing a difference the same day as injections is not expected.

 


Will this treatment continue long term?

The duration and repetition of treatment depends on the response to injections. This will be discussed at your first follow-up. For patients who find Botox helpful, it is safe to repeat injections 3-4 times per year for many years.

 
 

How much will Botox cost me?

This depends on your insurance. Some insurers require a prior authorization for our office to confirm treatment will be covered. The administrative staff can inform you whether this is the case for you. You may also contact your insurer directly for coverage information. If you have a co-pay, there is a co-pay refund program through Allergan you may be eligible to apply for, a separate packet on this is available.