If you had formula cov'd through Insurance, who is your carrier?

Im going through the process now....waiting on some paperwork.

I have GHI, through the DEA (Not PBA) and my DH asked some ppl at work and they said they all got denied

Re: If you had formula cov'd through Insurance, who is your carrier?

I think at the time we had United Healthcare. But we were denied for Allimentum/Neutramigen since it can be purchased in stores without a prescription. Once he was switched to Neocate it was covered.

I have heard that some people who were denied when they tried had good results when they contacted Apria. They seemed to have contacts within the insurance company who helped them get it covered.

Good luck!

Message edited 10/14/2010 10:41:29 AM.

Re: If you had formula cov'd through Insurance, who is your carrier?

I have Empire NYSHIP and my formula is covered.

Re: If you had formula cov'd through Insurance, who is your carrier?

i have United Healthcare PPO and my similiac Sensitive RS is covered.

Re: If you had formula cov'd through Insurance, who is your carrier?

Empire BC/BS Alimentum is 100% covered - they did approve Elecare too but he havent made the switch yet

Message edited 10/14/2010 10:45:33 AM.

Re: If you had formula cov'd through Insurance, who is your carrier?

I have Empire Blue Cross Blue Shield....it covers my DS's Enfamil Nutramigen.

Re: If you had formula cov'd through Insurance, who is your carrier?

I have Aetna.
Nothing was covered..not Elecare or Nutrmagin.

I was told it really depends more on your companies benefits, not the insurance company.

I put in two appeals and they were both denied.

GOOD LUCK!

Re: If you had formula cov'd through Insurance, who is your carrier?

Errrrrrrrrrrr..


just have to wait and see.

Re: If you had formula cov'd through Insurance, who is your carrier?

We have Empire Government and we were denied at first...It took a big fight to get DS's Elecare covered..After 2-3 weeks we finally got it....Keep fighting it if they refuse. Most insurance companies will cover most formulas if there is a medical reason for your DC to be on it...Good luck...

Re: If you had formula cov'd through Insurance, who is your carrier?

Unfortunately it has nothing to do with the insurance company itself, but rather the actual plan that you have under that insurance company.

That said, we have GHI and his Similac Neosure is covered, but ONLY in the powder form and it took a while to get it approved (didn't have to appeal anything, just took a while). Then when it was approved, we had no idea how to actually GET the formula so we lost time there waiting to hear back. Turns out we just needed to get a prescription from our doctor and take it to the pharmacy (wish someone had mentioned that to us early on, lol).

ETA: The formula has to be a medical necessity for the insurance company to usually cover it. For us, DS was a preemie and needs to be on preemie formula for extra calories, so it was approved.

Message edited 10/14/2010 11:42:45 AM.

Re: If you had formula cov'd through Insurance, who is your carrier?

we have united health care & they cover EleCare. You have to just keep fight for it. My GI dr & myself called the ins comp every other day to get my son covered it took about 3 weeks.
I was lucky to have enough formula to get me through the wait.

Re: If you had formula cov'd through Insurance, who is your carrier?

many insurers will only cover formulas for specific enzyme related diseases (like PKU or Maple Syrup Urine Disease), not for more "normal" issues like reflux or failure to thrive.

Each policy for each company is different, if you get denied, ask them for a copy of their actual medical policy regarding formulas. Some require that the formula be only available by prescription or that it be for tube feedings, not bottle feedings.

Also, if you DO get denied and it is an expensive formula, check around to DME companies because it may be cheaper for you to get it from them than the grocery/major retailer. They also may be willing to work with you on pricing.

Good luck.