Hypo-allergenic formula, how to get insurance to pay!

[lilmary]

Hello Ladies,

So many of you have been such great support so I wanted to share something that I hope will help some of you.  My dd is milk sensitive and soy sensitive and therefore must have hypo-allergenic formula.  We've been using Alimentum.  As any of you who use hypo formula know, it's very expensive.  I wanted to share with you how we were able to get our insurance to cover the cost.

Most policies have something called Durable Medical Equipment coverage, or DME for short.  This typically is used for wheelchairs, oxygen, crutches, Ensure, etc.  All you need to do is find a DME company that  carries hypo formula or supplies to children and can order it.  Have your doctor send a rx to that company and the company will contact your insurance company for authorization.  Your doc will most likely have to provide notes to prove that the formula is a medical necessity, but once that's determined and that it's the only source of nutrition for your child, your insurance may authorize it.

Now, I'm only going by our personal experience, and one would assume that each insurance company has it's own set of rules.  But this was what a supervisor with our insurance company recommended, and it worked.  We do have a cap of $2,000 per year for this coverage, but that's plenty! Also, most companies deliver or ship the formula to your door. 

Good luck!!!!

Mary
 

[Jimbob]

Thank you for posting that information I am sure that will help many people.

Kelly

[Zoey]

I think this should be stickied

[Jimbob]

Done

[Zoey]

You're the best Kelly, thank you 

Mary, thank you for the info - had I known this two years ago, I'd be a lot richer now lol.  Thank you for sharing!

[Mydreamcametrue]

WOW!  I really wish I had known this. Are you in the US? 

DS1 was on Hypoallergenic for 9 months and I was spending a little over $200.00 a month.  No one ever mentioned this to me.

DS2 was beyond hypoallergenic and was on Amino Acid.  I contacted the insurance company and they said they would NOT cover since you do not need a Rx for it.  I could not tell you how much I spent on that formula.

I have a friend that I am going to let know right away. 

Please let me know if you are in the US because I think this could help a lot of people. 

Thank you SO MUCH for the info.
Wendy

[lilmary]

Wendy,

Yes, I'm in the US.  Our insurance company originally told me no too, citing the fact that the formula could be purchased over the counter.  I can be very persistant when I want to be--sometimes for better and sometimes for worse  --and I asked to speak to a supervisor.  That wonderful woman took the time to research the issue a little bit and found the answer for me.  So, as long as you have Durable Medical Equipment coverage, which I think most policies provide for that, and your doctor can provide the proper notes to show a medical need, it should be covered.  The doctor sends a prescription to a DME company that supplies baby formula and that company then contacts your insurance company to seek authorization. 

We just got our first shipment today, delivered right to our door! It is a huge burden for families, especially for those that may already have restricted finances.  Our coverage does cap at $2,000 per year, but it's still a huge savings.  I hope that others have the same success that we've had.  Go get em!

Mary

[Spectra]

Does anyone know if this is covered in Canada under Blue Cross?

[motherof3]

This is how we got our insurance to cover Abby's Neocate!  I was also told no when I contacted them directly but was given the name/number of a DME company (APRIA).  They got our insurance to cover 80% of the cost the same day!!  I was completely shocked!   And also wanted to jump through the phone and kiss the lady that called me!

Andrea

[birdie]

I am so excited to read this post (now stickie). We just got the particulars on our new insurance plan today. We have 100 days of rental durable therapeutic equipment on our policy. So, I am wondering if would could make this stretch.

I would be happy to rent Ian's NEOCATE and gladly return it when we are done. (can you image opening that package...giggle, giggle).

I am going to talk to the HR director and DH's office tomorrow and see if she can get me in contact with someone who could better explain the policy.

I feel inspired.

Wendy

[Jimbob]

I hope you can get it covered soon.

Kelly