Special Needs

Should I call the GI now about the new formula or wait?

At DS's last appointment they gave us the go ahead to try yogurt which ended up being a diaster - he was gassy and miserable and had a very upset tummy for a few days after (we tried it twice over the month and same thing both times).  He's on Neocate now and they said that if he has issues they'll probably switch him to Neocate Junior.  Our next appointment isn't for almost two weeks so I am contemplating calling now to get the ball rolling since we have to get prior approval thru the insurance company before it can be ordered and filled and I am anticipating issues with this (another mom from our area mentioned that it was a long process because they were denied and then had to appeal).  Would you call or just wait ? 

TIA!

Re: Should I call the GI now about the new formula or wait?

  • I would call now. If you think he is going to need the new formula, then get the ball rolling so you can have it for him sooner. I know 2 weeks is a loooong time if my son is eating something that isn't working.

    Maybe they can give you a few cans of the Neocate Junior so you can see if that works better? That way by the time your appt comes you will be able to say, "See he has been on this one for a week now and things are so much better" etc.

    Katherine

     

    Katherine Proud Mommy and Foster Mommy
  • erinmserinms member

    So you think he will need to continue an elemental formula for a while longer because he did not tolerate the yogurt (just to make sure I understand completely)?

    I would call the GI office and ask to speak with a nurse, nurse practitioner (whoever helps the doctor with the prior authorizations and will have the time to help you out) and explain the situation. ?The prior authorizations can take forever, so it is good to get them started ASAP. ?That said, the Neocate Junior might be easier to get authorized than the Neocate was. ?Infant formulas are often really hard to get covered because the insurance companies think that you would have to pay for infant formula no matter what, so it is not a covered benefit. ?They just ignore the fact that some people would have breastfed for free if it weren't for their child's medical needs AND that the Neocate costs $50-75 per can, obviously way more than Enfamil. ?Since the Neocate Junior is not an infant formula, they seem to see it as more medically necessary. ?At least, this has been my experience with my patients in California. ?

    So, if you know one of the nurses or NPs, it would be good to go ahead and call one of them. ?They might make you wait until your appointment, but I would think they would like to go ahead and get started.

    ?Good luck!?

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  • I too would call the doctor and get the ball rolling. DS switched from Neosure to Milk and began breaking out, having increased feeding issues and began refusing a bottle all together. He has since been put on Nutramigen and at 3 cans a week we were out $270 until his insurance request was approved. If you are unable to speak with someone at the GI office I recommend going or calling DC pedi to see if they can help you with the approval!
  • Call now! 

     

    We are fighting our insurance company like crazy trying to get them to pay for the Neocate Junior.  We are guaranteed $1500 per year coverage and they keep refusing to pay for it since we ordered it from the Neocate company directly for $35 per can (instead of using their mailing company for $77 per can).  I am now on over 20 hours of phone calls, 2 appeals, appearing in front of an appeal board next tuesday, etc...

    The sooner you start, the better off you will be1  Good luck!

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