| Posted By |
Message |
ny55angel
car seat tech & geek :-)
Member since 2/06 4346 total posts
Name:
P
|
Formula covered by insurance-specifically GHI
Dh is an NYC employee so he has GHI. DD#2 has been put on Nutramigen due to her colic and reflux. Express scripts told me that since it is not an Rx they don't cover it. GHI says unless its given through a feeding tube they don't cover it. I know that people have gotten it covered so I was wondering how.
Has anyone had success in getting it at least partially covered? ? Especially because the dr wrote that it is a medical necessity?
|
Posted 3/21/13 3:29 PM  |
| |
|
Long Island Weddings
Long Island's Largest Bridal Resource |
Smileyd17
kids
Member since 5/05 20997 total posts
Name:
Mommy
|
Re: Formula covered by insurance-specifically GHI
A big fat NO!
they stopped that. i had it covered under my DD. twins came, same issue. nada.
No matter what I got denied.
|
| Posted 3/21/13 3:37 PM |
| |
|
JDubs
different, not less
Member since 7/09 13160 total posts
Name:
|
Re: Formula covered by insurance-specifically GHI
depends on your RX plan/union. I have GHI but Caremark RX. After a headache for a month trying to get Alimentum covered for my DS, I had to fax the union (who Caremark is through) a letter of medical necessity and they told me they would pay half. I have to get it through a pharmacy though.
However, my sister who has Medco, had the formula almost fully covered! She went through the same process (had to fax her union a letter).
Good luck!
|
| Posted 3/21/13 3:59 PM |
| |
|
missfabulous
#mommyneedswine
Member since 6/09 10031 total posts
Name:
Colleen
|
Formula covered by insurance-specifically GHI
What does your DH do?
ETA: I asked this b/c DH works for Sanitation and we found out that his union covers Nutramagin with a letter from the doctor that it was a medical necessity.
Message edited 3/21/2013 4:04:47 PM.
|
| Posted 3/21/13 4:04 PM |
| |
|
ny55angel
car seat tech & geek :-)
Member since 2/06 4346 total posts
Name:
P
|
Re: Formula covered by insurance-specifically GHI
Posted by missfabulous
What does your DH do?
ETA: I asked this b/c DH works for Sanitation and we found out that his union covers Nutramagin with a letter from the doctor that it was a medical necessity.
DH is sanitation! He's a supervisor though, local 444. Is your DH the same? I'll have to call them tomorrow and see.
Thank you!
|
| Posted 3/21/13 4:07 PM |
| |
|
missfabulous
#mommyneedswine
Member since 6/09 10031 total posts
Name:
Colleen
|
Re: Formula covered by insurance-specifically GHI
Posted by ny55angel
Posted by missfabulous
What does your DH do?
ETA: I asked this b/c DH works for Sanitation and we found out that his union covers Nutramagin with a letter from the doctor that it was a medical necessity.
DH is sanitation! He's a supervisor though, local 444. Is your DH the same? I'll have to call them tomorrow and see.
Thank you!
He's not a supervisor, just a regular worker. But the union does cover it up to $6500. Get a letter from your doctor adn save your reciepts.
|
| Posted 3/21/13 4:09 PM |
| |
|
ny55angel
car seat tech & geek :-)
Member since 2/06 4346 total posts
Name:
P
|
Re: Formula covered by insurance-specifically GHI
Posted by missfabulous
Posted by ny55angel
Posted by missfabulous
What does your DH do?
ETA: I asked this b/c DH works for Sanitation and we found out that his union covers Nutramagin with a letter from the doctor that it was a medical necessity.
DH is sanitation! He's a supervisor though, local 444. Is your DH the same? I'll have to call them tomorrow and see.
Thank you!
He's not a supervisor, just a regular worker. But the union does cover it up to $6500. Get a letter from your doctor adn save your reciepts.
Thank you sooo much!!
|
| Posted 3/21/13 4:14 PM |
| |
|
VeeJay
Love baby feet
Member since 2/09 2894 total posts
Name:
|
Re: Formula covered by insurance-specifically GHI
I don't have GHI but I do get Alimentum covered through my insurance. I go through Apria Health (they supply the formula) and they bill my insurance. I had to get a letter of medical necessity from my pediatrican's office.
|
| Posted 3/21/13 4:52 PM |
| |
|
babylove628
mommy of two!
Member since 11/09 2733 total posts
Name:
Maggie
|
Formula covered by insurance-specifically GHI
I have GHI but our Alimentum is covered though DHs union, he's a NYC teacher. Call the union.
|
| Posted 3/21/13 4:54 PM |
| |
|
tara73
carseat nerd
Member since 11/09 3669 total posts
Name:
Buttercup
|
Re: Formula covered by insurance-specifically GHI
Should be covered per NY insurance law
http://www.dfs.ny.gov/insurance/ogco2001/rg105181.htm
You will have to get a letter of medical necessity from your doctor, but special formula for GERD (reflux) is supposed to be covered by NY health plans. You may have to go through a DME type company too, like Apria.
Call your regular health plan and discuss your DME benefits, not your pharmacy plan. Pharmacy plans don't tend to deal with enteral formulas.
|
| Posted 3/22/13 9:21 AM |
| |
|
ali120206
2 Boys
Member since 7/06 17795 total posts
Name:
|
Formula covered by insurance-specifically GHI
We have GHI and we would have been able to get DS' Gentlease covered with just a copay- we got the note and then they said it needed to be a phone call. We ended up not going that route because the copay was the same price (and less of a headache) to use coupons and get it at BJs.
DH is in the FDNY.
Message edited 3/22/2013 9:25:19 AM.
|
| Posted 3/22/13 9:24 AM |
| |
|
Traysee
LIF Adolescent
Member since 12/10 652 total posts
Name:
|
Formula covered by insurance-specifically GHI
My twins were on Elecare. We were initially denied thru BCBS / Medco but we filed an appeal. We had a letter from my girls GI stating that it is medical food. They reimbursed us for all formula for their first year, which ended up being about $600 a month I think. It's worth exhausting all options and possibly even asking to switch to a different formula if that one is covered. Nutramegin you can get in stores maybe if it's something harder to get like Alimentum or Elecare you might be able to get it covered?
The elecare rep and my GI's office manager really pushed for it.
Message edited 3/22/2013 9:50:53 AM.
|
| Posted 3/22/13 9:50 AM |
| |
|
ISpoilHim
I think I got this
Member since 11/10 1523 total posts
Name:
K
|
Formula covered by insurance-specifically GHI
DS used Enfacare (high calorie for preemies). I had called insurance company before his discharge from hospital and they told me that as long as I had a prescription from the dr, it was covered. It is available in stores OTC, but we filled our RX at CVS and everything was fine.
I have emblem health underwritten by GHI
|
| Posted 3/22/13 10:23 AM |
| |
|
donegal419
St. Gerard, pray for us.
Member since 7/07 7650 total posts
Name:
K
|
Re: Formula covered by insurance-specifically GHI
Posted by babylove628
I have GHI but our Alimentum is covered though DHs union, he's a NYC teacher. Call the union.
Same here, but DS needed nutramigen. Was covered for a $35 a month copay. Their months supply covered us for almost 2 months so i had more than enough.
|
| Posted 3/25/13 9:29 AM |
| |
|
MrsKelly
just hangin' around...
Member since 11/06 6305 total posts
Name:
Krista
|
Re: Formula covered by insurance-specifically GHI
Posted by JDubs
depends on your RX plan/union. I have GHI but Caremark RX. After a headache for a month trying to get Alimentum covered for my DS, I had to fax the union (who Caremark is through) a letter of medical necessity and they told me they would pay half. I have to get it through a pharmacy though.
However, my sister who has Medco, had the formula almost fully covered! She went through the same process (had to fax her union a letter).
Good luck!
We have ghi/caremark as well and are weaning dd onto alimentum now. To get it covered, do i call caremark or ghi? And what pharm did you get alimentum through???
|
| Posted 3/25/13 9:56 AM |
| |
|
JDubs
different, not less
Member since 7/09 13160 total posts
Name:
|
Re: Formula covered by insurance-specifically GHI
Posted by MrsKelly
Posted by JDubs
depends on your RX plan/union. I have GHI but Caremark RX. After a headache for a month trying to get Alimentum covered for my DS, I had to fax the union (who Caremark is through) a letter of medical necessity and they told me they would pay half. I have to get it through a pharmacy though.
However, my sister who has Medco, had the formula almost fully covered! She went through the same process (had to fax her union a letter).
Good luck!
We have ghi/caremark as well and are weaning dd onto alimentum now. To get it covered, do i call caremark or ghi? And what pharm did you get alimentum through???
Hi, You have to call the PBA (i am assuming this is your union too?)... tell them you need your LO's formula covered, and then get their fax number, fax over the letter from your doc saying the formula is a medical necessity (the ped should be able to do this for you w/o a problem). Then get an RX from your doctor. The PBA will pay half through Caremark. I fill mine through Target Pharmacy because I noticed it was a little bit less than CVS... I pay approx $135 a month for 5 cases. I just fill it as needed.
|
| Posted 3/25/13 10:27 AM |
| |
|
