Elecare covered by insurance? — The Bump
Food Allergy

Elecare covered by insurance?

Has anyone had Elecare covered for their kid without having a metabolic issue or feeding tube? We have Cigna.  

My four-month-old son was diagnosed with failure to thrive at one month old. He was three percentile at one month, and then at one and a half months fell down to 1 percentile, and by two months had fallen off the growth charts completely. I had tried breastfeeding and supplementing with regular formula, and then just formula only. He would gain, but hardly anything. 

When we saw a GI at two and a half months old, she saw that he had malabsorption, and she put him on Elecare to test for allergies. 

He gained three pounds in three-and-a-half-weeks on Elecare. The Gi said that means he has allergies, and she said she would have her nurses call my insurance with the diagnosis to see if they would cover it. 

From everything I have heard from parents with kids on Elecare, I thought the likelihood of it getting covered was high. We have really good insurance. 

However, thirty minutes after I left, the nurse called and left a message. I didn't see it until just now, but she said that private insurances usually don't cover Elecare unless the kid had a feeding tube or is diagnosed with a metabolic issue. I am going to call her tomorrow morning to find out if she even sent the information to my insurance since she called thirty minutes after I left. 

My kid may not have a feeding tube or a metabolic issue, but he did not gain weight until he started Elecare. He was so skinny. 

Re: Elecare covered by insurance?

  • My daughter is also on an elemental formula (puramino) and I found a Facebook group that is a pretty small with people having similar issues. I read a comment someone made that if the insurance rejects it you can appeal against it and that they had success with that. I believe there is an appeal form under each insurance to do so. From what I'm gathering it is a process. Right now I'm currently waiting to see if mine gets approved. 
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