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Mdolph6
So in Love....
Member since 3/07 1622 total posts
Name:
A Family of 4
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Can you believe this?? (PED VENT)a little long...(small update)...(update #2)
My daughter has been on nutramigen for the past 3 months after trying 4 other formulas......She does great on it and I KNOW she needs to be on it...here is the problem.....11 days ago I took her off it and put her on gentlease because money is very tight and it was costing us $100 a week...so now she has not been sleeping well, she has bad gas, she screams for about 2 hours a day and she has had blood in her poops twice.....
I called the Ped yesterday morning at 930am and he finally called me back this morning....I told him all the problems she is having and asked if there was any other formula she can try that might be cheaper...he said no there is not and I should just "save my pennies".....Then more into the conversation with him he said that I can call my ins company and see if they will pay for it and I told him that we already tried to do that and his office told the ins company that the baby was COLICKY so they denied it.....I then said to him that there is obviously more wrong with her then being colic....so then he said "some insurances are better then others,(I have a great ins, my DH is a teacher so his ins is great) maybe I should think about taking out a 2nd mortgage".....now I am sure he was joking about that but you dont say that to a crying mother who is just trying to her her child....
I am soooo upset right now I dont even know what to do....
Maybe I should change my Ped???? My husband is going to flip out when I tell him what the dr said....so if anyone can recommend there Ped that might be helpful to me just incase we decide to switch.
(we already tried Apria and Continued care)
Thanks for listening and letting me vent. 
**Update**
My DH called the ped office to speak to the dr about how unprofessional it was the way he talked to me...he didnt speak to the dr though, he spoke to the office manager who apoligized and told him they will submit another claim to the insurance company...
Wish us luck!! My poor DD really needs this
**UPDATE #2**
So now a week after my DH spoke to the manager who said they would contact the insurance company....NEVER DID....they said it was not even looked at...SO he FLIPPED OUT on them and again they told him that they will submit it tomorrow....so needless to say we NEED to find another PED.....Im soooo upset...but its for the best I guess!!
Message edited 8/7/2008 1:14:32 PM.
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Posted 7/31/08 10:09 AM  |
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nbc188
Best friends!
Member since 12/06 23090 total posts
Name:
C
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Re: Can you believe this?? (PED VENT)a little long
 Aw, that really stinks. I would be annoyed too! It's no time to joke with a mother stressed by trying to do the right thing for her baby 
Hopefully others on here will have advice, since I don't have any experience with that formula.
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| Posted 7/31/08 10:13 AM |
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zeta1996
YUMMY!
Member since 9/06 2365 total posts
Name:
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Re: Can you believe this?? (PED VENT)a little long
Is there a way to have the PED say it is medically necessary to have this formula?? Maybe call your insurance to see what exactly they need to get it covered. 
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| Posted 7/31/08 10:18 AM |
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smdl
I love Gary too..on a plate!
Member since 5/06 32461 total posts
Name:
me
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Re: Can you believe this?? (PED VENT)a little long
Not exactly good bedside manners. I would be ticked off a bit by those comments.
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| Posted 7/31/08 10:19 AM |
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Mdolph6
So in Love....
Member since 3/07 1622 total posts
Name:
A Family of 4
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Re: Can you believe this?? (PED VENT)a little long
Posted by zeta1996
Is there a way to have the PED say it is medically necessary to have this formula?? Maybe call your insurance to see what exactly they need to get it covered.
He said to me she must be on it but since they already tried once before his answer to that was "some ins are better then others" 
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| Posted 7/31/08 10:19 AM |
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jes81276
summer fun!
Member since 3/06 4962 total posts
Name:
Jaime
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Re: Can you believe this?? (PED VENT)a little long
Where are you located?
I am surprised that his office would use the word colicky - they know the correct terminology to get the formula covered and Empire insurance definitely does cover formula. DS is on Allimentum and there was never an issue with it being covered through Empire
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| Posted 7/31/08 10:20 AM |
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Re: Can you believe this?? (PED VENT)a little long
My husband works in a school as well, so we have the same insurance (I think) and they covered DD's Alimentum because the Ped wrote it as "severe formula allergies"....
I would either demand that the doctor write a prescription for your DC and cooperate with you to get the insurance company the information it needs, or I would switch Peds...where are you located?
Message edited 7/31/2008 10:21:28 AM.
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| Posted 7/31/08 10:21 AM |
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Mdolph6
So in Love....
Member since 3/07 1622 total posts
Name:
A Family of 4
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Re: Can you believe this?? (PED VENT)a little long
Posted by jes81276
Where are you located?
I am surprised that his office would use the word colicky - they know the correct terminology to get the formula covered and Empire insurance definitely does cover formula. DS is on Allimentum and there was never an issue with it being covered through Empire
We are in Bay SHore.
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| Posted 7/31/08 10:26 AM |
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JavaJunkie
Someday, Somehow
Member since 6/05 5857 total posts
Name:
Lois
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Re: Can you believe this?? (PED VENT)a little long
The ped needs to write a letter of medical necessity due to formula allergy, if's she pooping blood it's more than colic! With that letter your insurance will cover it. DS was on Neocate for 8-9 months and it was covered. They did deny it a few times and we had to keep fighting them and finally they paid it. I seriously think they deny stuff just to see if people will just give up. Under NYS law if it's the only formula your child can have to survive they have to cover it unless you have private insurance, which I'm guessing you don't. HTH
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| Posted 7/31/08 10:33 AM |
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JRG71
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Member since 5/05 5025 total posts
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Re: Can you believe this?? (PED VENT)a little long
Take your DC to an allergist and have her tested for a milk protein allergy. Or ask the staff in your peds office to resubmit the insurance claim that it's medically necessary for DC to be on it because of blood in the stool, cramping and gas.
There is no reason that your DC should suffer because your ped's office is stupid.
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| Posted 7/31/08 10:39 AM |
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Re: Can you believe this?? (PED VENT)a little long
Will your insurance cover going to a stomach doctor? Maybe they can find a reason for the blood and give th einsurance company the info. My friend had alimentum covered simply by saying not gaining weight.
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| Posted 7/31/08 10:51 AM |
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BaroqueMama
Chase is one!
Member since 5/05 27530 total posts
Name:
me
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Re: Can you believe this?? (PED VENT)a little long
That's completely unacceptable, imo. I was in a VERY similar situation when my daughter was about 6 weeks old and I switched peds. because no one was taking my daughters milk allergy seriously at the office I was going to. I honestly think you need to switch peds. to someone who is looking out for your child's best interest
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| Posted 7/31/08 11:30 AM |
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Michelle
My Little Yankee Fans
Member since 1/06 4018 total posts
Name:
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Re: Can you believe this?? (PED VENT)a little long
If your daughter has blood in her stool it is medically necessary. I would bring her to a GI Dr, and get a script for the formula thur them. That was all Apria needed was the script to get it covered.
Good Luck, I would call the Dr's office back and tell them you want a script for it one that says it is medically necessary or you want a referral to a GI Dr.
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| Posted 7/31/08 11:57 AM |
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rmdrn125
LIF Toddler
Member since 5/07 497 total posts
Name:
mom mom
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Re: Can you believe this?? (PED VENT)a little long
OMG!! call your insurance again and ask them exactly what the ped. needs to write as the diagnosis, and if your pediatrician wont do it, then leave them.
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| Posted 7/31/08 12:20 PM |
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Mdolph6
So in Love....
Member since 3/07 1622 total posts
Name:
A Family of 4
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Re: Can you believe this?? (PED VENT)a little long...(small update)
Posted by rmdrn125
OMG!! call your insurance again and ask them exactly what the ped. needs to write as the diagnosis, and if your pediatrician wont do it, then leave them.
My ped office said today that they would resubmit a claim for it...so we will see
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| Posted 7/31/08 7:12 PM |
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Mdolph6
So in Love....
Member since 3/07 1622 total posts
Name:
A Family of 4
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Re: Can you believe this?? (PED VENT)a little long...(small update)...(update #2)
Posted by Mdolph6
Posted by rmdrn125
OMG!! call your insurance again and ask them exactly what the ped. needs to write as the diagnosis, and if your pediatrician wont do it, then leave them.
My ped office said today that they would resubmit a claim for it...so we will see
AND NOTHING!!...
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| Posted 8/7/08 1:15 PM |
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