Insurance coverage for formula?

firsttogo

We are having trouble getting coverage for Pregestimil for our youngest. He has a soy/milk protein allergy, as well as some malabsorption issues, and has to be on this formula. We make "too much" to qualify for WIC, but not enough to be able to comfortably pay for the formula.

Does anyone have any suggestions We seem to be hitting a wall here. I have a letter of medical necessity, and supporting documentation.

If insurance denies it, where do we go from here. 

stillhoping

Go back to wic, insurance refused to pay for my triplets formula as well, Douglas had the same issue, and all three were put on the expensive formula as a result. Our doctor was able to give us a lot of free formula and I wrote the company and they sent me coupons and free as well.

 

I was spending 250.00 a week on formula

livinreality

Will your insurance cover any formula? My would not cover nutramigen but would cover Neocate which is a prescription formula (we are on it for soy/milk intolerance and a sensitive stomach issues)

stillhoping

Nothing

bryan'sgirlM

I am a registered dietitan and work for a large pediatric hospital in the Home Care office and I deal with this exact situation daily.

The majority of commercial insurance companies will NOT pay for any kind of infant formula unless the child has a diagnosis of inborn error of metabolism, like PKU (phenylketoneuria).

A select few insurance companies will cover formula related to cow's milk allergies/food allergies/malabsorption with supporting documentation.

For families that are in your situation, the hospital I work for has a program called financial assistance/uncompensated care which families can apply for to get coverage of formula through the home care office. 

The other option would be to contact Mead Johnson, who makes Pregestimil, and see if they have any programs to help families in your situation. 

earthycrunchymama

There is currently Legislation for Coverage for Medical Foods

Sen John Kerry (D-MA) just started it. I HIGHLY recommend you (and anyone else affected) contact him and share your story. They NEED it to pass federal legislation for those affected by PKU and other metabolic disorders.

Your state laws may vary. also ask your state senator to help!!!

 My state doesn't mandate coverage for this, and I'm spending over half my income of medical foods. (we have state legislation pending since '05 for this - which is why you should contact your legislators!)