Empire Health Insurance and Elecare formula

DS was put on Elecare this past week due to severe allergies. We contacted our insurance company to get it through them and we were told that they don't cover it. We got 2 cans at CVS yesterday and they cost 51 dollars each. Yikes. Through the website they are 30 dollars a can. 14 ounce can will last us about 3 days. We can't afford to pay those prices. When we called the insurance company back to tell them that it is a medically necessary for DS to have this formula, they told us we could appeal the situation. Does anyone have Empire health insurance or have you been in a situation like this? We basically have cancelled Christmas.

Update at bottom....

Message edited 12/14/2009 5:06:38 PM.

Re: Empire Health Insurance and Elecare formula

I have the empire plan and my boys are on elecare. It is covered. I would call and fight it. Make sure you get a script. Good Luck

Re: Empire Health Insurance and Elecare formula

Thank you. We are going to call them again on Monday from the doctor's office. Thank you very much.

Re: Empire Health Insurance and Elecare formula

Not sure if it is the same thing, but I have Empire Blue Cross/Blue Shield. Our Elecare is covered 100% -- not even a copay. I had to submit a letter of medical necessity from the GI doc and a prescription for it. I think it depends on the plan that your company pays for b/c when I called Apria (the homecare company that supplies it to us) about it, they looked up my plan and then came back on the phone and said, yes your plan covers it.

Also, until it gets approved by your insurance, ask your GI doc for samples. I didn't have to pay for any of it -- I got all samples until I got my delivery from Apria.

Re: Empire Health Insurance and Elecare formula

not sure which empire you have...did you have the doctor's office help fight it? have you called the supply companies-apria and/or homecare supply-to see if they can help too? they do this often and are so knowledgeable!

Re: Empire Health Insurance and Elecare formula

I called Apria Healthcare (1-877-536-8372 - they are a supplier) and you give them your insurance info and they contact your insurance and find out for you. Its a 5 minute call and you will find out within 48 hours. You have to fax them in a script. I get a supply ever month, delivered to my door. They are wonderful....I never had to talk to insurance.

I have empire bc/bs but I am also almost positive that empire govt gets it covered as well!

Re: Empire Health Insurance and Elecare formula

Re: Empire Health Insurance and Elecare formula

I have empire NYSHIP. The appeal process is not that bad. It's pretty much guaranteed as long as your doctor considers it medically necessary.

ALSO!!! SAVE ALL OF YOUR RECEIPTS. THey will pay you for all the money you lay out from the point that you make your first call until they start delivering the formula. You will just need to fill out some paperwork to get paid retroactively.

My elecare is delivered right to my door one time per month. I'm sure it will be approved. Don't cancel Christmas!

You need to talk to someone on the Empire phone line that handles homecare supplies.

Re: Empire Health Insurance and Elecare formula

Do you have the Empire Plan or Empire Blue Cross Blue Shield? ( they are two entirely different companies?)

I used to work for Empire BCBS...they 100$ cover this, the rep's unfortunatly don't always know how to do this. you need to speak to a supervisor. Also your Dr's office should be helping you do this.

And I 100% second just calling Apria...if you have BCBS, they work with them and they can get it all done for you.

Call The insurance, speak to a supervisor , Tell them its a NY SATE MANDATE that they cover this ( unless they tell you your company is exempt)...Then call your Dr"s office and say you need help with the insurance ( you defintly will need a letter of medical neccesity) and third, call Apria...

If you dont get an answer and it covered right away, PLEASE FM me. I can help you get it covered through the insurance....and also have a few cans I can spare so you dont have to pay for it.

Re: Empire Health Insurance and Elecare formula

Thank you every one for this information. I am going to do everything you all said. I am going to the pedi's office on Monday and have them help me. And then I am going to go the the pedi GI and get some samples. I will keep you all posted.

Re: Empire Health Insurance and Elecare formula

We have Empire and had the same issue....It took a while to finally get the right person to help us but it is completely 100% covered!

Where do you live? I have a few unopened cans left if you want them.

If anyone wants the cans please FM me.

Message edited 12/5/2009 2:31:13 PM.

Re: Empire Health Insurance and Elecare formula

Empire BCBS covers my DD's neocate 100% but it took many phone calls between myself, my drs office, bcbs, and their 3rd party vendor to actually get everything straightened out. Good Luck!

Re: Empire Health Insurance and Elecare formula

I forgot, I also have 8 cans of Nutramigen AA I can donate-my son just went off formula-its the same thing as Elecare(amino acid formula)

Re: Empire Health Insurance and Elecare formula

Re: Empire Health Insurance and Elecare formula

We are still battling with the insurance company. They out right refuse to help us in any way. The doctor's office is having the same problem. No one will give us a number to call or a person to contact. It is getting really frustrating. Hubby is beyond ****** and that is not good for his health. We are down to 2 cans of formula which won't get us through the week. A big thanks goes out to a member on here for helping us out. I don't know what to do. Way too much stress going on here and it is affecting all of us.

Re: Empire Health Insurance and Elecare formula

I am SO sorry that you are still having a problem with this! Have you spoken to the people at Empire that deal with home care? They are the ones that finally solved our problem.

Re: Empire Health Insurance and Elecare formula

I have Empire and got Alimentum covered for DD by contacting the office that handles home health care supplies (like for diabetics etc.). See if you can get to that office by contacting Empire. My pediatrician also had to call on my behalf for the prescription. It took a few weeks to straighten out but we finally got it covered. Do not try to go through your prescription drug plan, this was a dead end for us.

Re: Empire Health Insurance and Elecare formula

I have an unopened can I can send you...I also have Neocate...let me count the cans and make sure I have enough to get my daughter through and I will be glad to send some of that if you need it! FM me with your address and I will put it in the mail tomorrow!

Re: Empire Health Insurance and Elecare formula

Re: Empire Health Insurance and Elecare formula

We called Apria today and gave them all the info. They said it would take 48 hours to hear something. When we called Empire, they gave us the run around. No one would give us any information on who to contact. Apria was the ones who gave us a number for the Pedi's office to fax over DS's prescription and health information. The Pedi office was also having a hard time with them. I am going to make some more phone calls tomorrow.

Re: Empire Health Insurance and Elecare formula

Rusty I was dealing with the same issue. I have empire NYSHIP too. Call 1-877-769-7447 then it is options 1 then 3 then 4. You have to go through the divison that deals with home delivery of medical supplies NOT prescriptions. Then your doctor would have to call the same number and same options, they fill out a form and fax it back. My DD is on nutramigen I call like 30 times over the past 2 days and spoke with a bunch of idiots who had no clue till I got someone who actually cared enough to look into things for me. Anycase, they said they would cover it 100% due to medical allergies (something about enteral formula vs. another type) and mailing me the supply monthly. I do have to say I am waiting for the final approval (my ped. was faxing the papers today) but try that department. Hope this helps!!!

Re: Empire Health Insurance and Elecare formula

We fought and fought but our insurance would not cover Elecare.

If you wind up paying out of pocket, buy from ebay. Much cheaper and safe.