Services for Injuries from "Fake" BOTOX not Covered by Health Plan

November 21, 2008 ( - The 11th U.S. Circuit Court of Appeals has upheld a ruling by a lower court that Blue Cross and Blue Shield of Florida was correct in denying medical coverage for treatment of injuries health plan participants received after being injected with a BOTOX substitute.

In its opinion, the appellate court said it found no reversible error in the district court’s decision and that the lower court “correctly found that BCBSF did not misinterpret the language of the [plaintiffs’] health insurance plan when it denied their claims.”

The court rejected Eric and Bonnie Kaplan’s argument that the substitution of raw botulinum-A toxin for BOTOX tranformed the medical services they later received to treat their resulting injuries into covered services. BCBSF had denied their claims, finding that the injections were “cosmetic services,” not covered under their health insurance plan and that the medical care the Kaplans required as a result of those injections were “complications of non-covered services,” also not covered.

The Kaplans began receiving BOTOX Cosmetic injections for purely cosmetic purposes from Bach McComb, a one-time osteopath who had lost his license to practice medicine in Florida. After receiving several injections without incident, they suffered severe injuries when, on one visit, McComb substituted raw botulinum-A toxin for BOTOX.

The Kaplans submitted approximately $800,000 of resulting medical bills to BCBSF.