Similac Alimentum and Insurance co.

I was on the Similac forum the other day and there was a thread for Alimentum, apparently if your insurance company denies your claim but you are covered under another company for prescriptions, you can try with them.

In my case, we have GHI for medical but my husbands union (UFT) covers RX through a company called Medco. I called them and Alimentum is covered, I just have to fax them a letter from my dr. and pray it gets approved. I also spoke to the pharmacist at the UFT who handles the claims and he told me to just send over the info and he can approve it for us.

OMG I hope this works, this formula is so $$$!

Has anyone tried getting forumla covered this way?

Re: Similac Alimentum and Insurance co.

I did, have GHI back with my DD it worked.

Fast forward 3 yrs later, twin boys- same situation- DENIED!

GHI didnt cover, and our RX is DEA so nada. I tried HIGH AND LOW!

GL, I hope it works out for you!

Re: Similac Alimentum and Insurance co.

i had medco through my job at the time DS was born and we needed alimentum and they would not cover it. even with letters, appeals, etc.

however, my friend who is covered through UFT got all her alimentum for 2 kids covered; cases delivered every month to their door and i think all they had was a copay. So maybe through the UFT / Medco program its covered; under my medco plan it was not.

Re: Similac Alimentum and Insurance co.

I have NYSHIP and my scripts go to medco. I called but its not covered. By the end of this month DS and I will be on DH insurance which is GHI. I'm hoping to get it approved

Re: Similac Alimentum and Insurance co.

we have GHI and express scripts for prescription (thru the union) express scripts denied it told us to go thru GHI.
GHI at first said they would cover it but then said maybe then in the end said no.
we went back to the union and thru calls back and forth,the union put pressure on express scripts and express scripts agreed to pick up 50%.
the union agreed to pick up another 20%.
i still pay over 130 a month for it - ALOT less than what i would have been paying out of pocket.


if ur prescription coverage is thru the union fight the union!

Re: Similac Alimentum and Insurance co.

NY law requires payment for formulas required by prescription.

We have to get Neocate for DD2, this is from their website.

New York
Expand State
Collapse State

Bill name: Article 32 – Insurance Law

Effective date of the law: 1994

Your coverage:

* Insurance reimbursement for amino acid-based formula for the treatment of conditions that include, but are not limited to, inherited diseases of amino and organic acid metabolism, Crohn's disease, gastroesophageal reflux disease (GERD) with failure to thrive, disorders of gastrointestinal motility such as chronic intestinal pseudo-obstruction and multiple severe food allergies


http://www.ins.state.ny.us/ogco2001/rg105181.htm

Re: Similac Alimentum and Insurance co.

I begged to have this covered I have 1199 insurance they wouldnt cover it


thankfully alot of ladies helped me on here I thank my lucky stars for them everyday. You ladies know who you are

Re: Similac Alimentum and Insurance co.

We have GHI and Medco and were not able to get it covered. They said in order to get it covered the child must not be thriving, which was not the case for us.