Getting Neocate or Elecare on 1199 insurance

My LO needs to be on Neocate or Elecare. We found blood in his poop, tried Alimentum for 3 weeks and the blood hasn't disappeared. Neocate and Elecare are very expensive and I know some ppl were able to get it covered on their insurance. The Neocate and Elecare website says NYS law mandates that insurance covers these special formulas, but I was wondering if anyone will 1199 insurance was able to get it covered. If so, how did you go about it? Thanks!

Re: Getting Neocate or Elecare on 1199 insurance

my dd needed Alimentum, I have 1199 insurance they told me they would not cover it

Re: Getting Neocate or Elecare on 1199 insurance

Call thE company. Neocate sent me a free sample (4 cans worth about $200) while I waited for insurance to go through. It was at my door the next day. I don't know about your insurance but I felt like it was a maze trying to figure out how to get it covered.

Some people told me to call Apria Healthcare because they helped a lot of people. They will supposedly help check your insurance.

Good luck!

Re: Getting Neocate or Elecare on 1199 insurance

I had my doctor write a letter to insurance. But we don't have 1199 insurance. You can also try buying some discounted on ebay or craigs list. I had given away about 13 cases of formula on craigs list because we switched to a toddler formula. Maybe you'll be able to find someone that has extra to give away or sell at a discount.

Also my doctor always had free samples. I never took them because insurance covered the Neocate but try their.

Re: Getting Neocate or Elecare on 1199 insurance

Just an update... my LO is doing great on Neocate and I finally got the Neocate covered on 1199! I just wanted to post this so that other moms who have 1199 will be able to get Neocate/Elecare covered as well.

Neocate is covered through 1199's prescription drug benefit (Medco), but it requires a prior authorization. It must be approved by 1199, and NOT medco. If you call Medco, they will tell you it is not covered, with or without a prior authorization. If you call 1199, they tell you that it won't be covered b/c it's an OTC formula. You need the doctor to fill out a prescription authorization request form (http://1199seiubenefits.org/wp-content/uploads/2010/12/140.pdf) and have it faxed to 1199 with a letter of medical necessity and a prescription. I called the company that makes Neocate and they have a department that handles insurance reimbursement. They were the ones that pointed me into the right direction. If you let them handle the prior auth process, they will send you 4 cans of Neocate for free (thanks jdbaby). I just had to get the medical notes from the doctor, letter of medical necessity and prescription faxed to the Neocate people and they fill out the paperwork, fax it back to md for signature and sent to 1199. I received a call from 1199 a few days later and was told it was approved. Then you take your prescription to the local pharmacy and have them order it.

Re: Getting Neocate or Elecare on 1199 insurance

Re: Getting Neocate or Elecare on 1199 insurance

Posted by Larasmommy

wow that is AWESOME I was that 1199 mom that was told "sorry its not covered". I am saving this post just in case my next baby due in February also has a milk protein allergy. Thank you so much for this info

Re: Getting Neocate or Elecare on 1199 insurance

my sister in law has a bunch of elecare left over from my nephew - FM me if you're interested

Re: Getting Neocate or Elecare on 1199 insurance

I have 1199 and I was going to say I highly doubt, they are so tough! I'm so glad you got it covered I'll definitely remember this in case any of my co-workers ever need it!

Re: Getting Neocate or Elecare on 1199 insurance

What is 1199 insurance. Our insurance won't cover it either bc it being a self insured plan iwas wondering if that was one in the same