Elecare formula help!

I was just informed that my 2 month old son is having such bad stomach issues that he needs to be switched from Nutramigen to Elecare. My insurance company won't cover Elecare and it's about $50 for one can of formula. Does anyone know the cheapest way to handle this?

Re: Elecare formula help!

fm sent

Message edited 8/25/2011 12:34:44 AM.

Re: Elecare formula help!

Keep fighting your insurance company... They told us the same thing and after about 6 weeks of fighting it, they agreed to cover it. It was a long battle and I got ugly with them. I threatened to go to the news. It was the ONLY formula my son could have and without it, he would have been hospitalized for god only knows how long. I told the insurance company that it would be cheaper for them to cover the formula then to have DS in the PICU for an indefinite amount of time.. We got it delivered to the door once a month.. My pedi's office kept sending them letters of necessity too.. DS was on it for 15 months! Try to order it through their company. That was the cheapest I saw it when we had to pay for it out of pocket. Also ask your dr for samples. I donated 8 cans to our pedi about 2 months ago.

Re: Elecare formula help!

The diagnosis was a milk allergy and I do have a prescription for it. We have Aetna. We have spoken to them about this a few times because they also wouldn't cover the Nutramigen when we went to that. They are steadfast that the plan that my husband's company chose will not cover any formula unless it's through a feeding tube.

Re: Elecare formula help!

Re: Elecare formula help!

Check out the Elecare website. They have a lot of information on there about insurance and they have a reimbursement plan. It is 204 dollars for a case of formula (6 cans). It cost us over 300 dollars when we ordered it through CVS...

Re: Elecare formula help!

gotta love the ipad,
I agree with everything already said. Neocate might b easier then elecare but i believe its pretty much the same thing.
I know they try to tell u its not covered but yes u hve to fight and that girl I know from the medical supply comp fights it for u as well. A allergy is a medical problem. I also know it def helps to have a letter of urgency that sounds as desperate as the situation is,
it stinks for sure, good luck n let me know if I can help

Re: Elecare formula help!

I have no advice because we went through similar issues when DS was little and had a milk protein allergy.

I was able to find formula cheaper on Craigslist, got donations from my pediatrician and then fortunately, DS was able to handle soy after a couple months.

He will be 3 in December and now drinks milk like a champ.

I had people FM and call me and tell me to lie to the insurance company (fraud) and say he was going to die and basically go in and make a scene at the doctors office and lie about his symptoms until I got free cases, and I'm sorry, it's expensive but I just can't bring myself to act like that. We are not rich people and I pay out of pocket every penny for my insurance which is over $350.00 a week.

Re: Elecare formula help!

It's required to be covered by insurance for certain diagnosis in NY. We use Neocate which is the same type of formula as Elecare and found this helpful from their website

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

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.neocate.com/reimbursement/insurance-coverage-map/#new-york

We had to "remind" Cigna that it was covered in NY state by law.