Formula Insurance Coverage

Sillylttleone

FYI - I work for a major insurance company and we cover baby formula with a prescription from the doctor to get it over the counter (even though it is the the same brands as buying it off the shelf) at no cost. Before spending lots of money, check your insurance to see if you have coverage for this... Every penny helps!

Kellysh31

I just looked on my insurance website and they only allow that for two reason if "specific nutritional support is considered to be a medical item only when it is administered enterally (i.e., by feeding tube) or parenterally (i.e., by intravenous administration) where the member has either (a) a permanent* non-function or disease of the structures that normally permit food to reach the small bowel; or (b) disease of the small bowel that impairs digestion and absorption of an oral diet, either of which requires enteral or parenteral feedings to provide sufficient nutrients to maintain weight and strength commensurate with the member's overall health status"

 

Kellysh31

what insurance company is that?  Does it come from behind the counter or do you go tot he shelf pick it up and then take it to the pharmacy to check out?  Is it any kind of formula?  Sorry for all the questions, I'm going to ask my DH to check his insurance as well because this would be really helpful.   I dont think mine does this.  Can you PM if you dont want to say what company it is.  Thanks!  Kelly

livinreality

My insurance covers special formulas (for example nutramigen, alimentum) as DME and will cover 70% if ordered through a participating DME provider... you do need a prescription/recommendation from your pediatrician.  

Our old insurance covered these formulas through the prescription drug program at the highest copay, so it is worth talking to both the DME and the prescription departments. 

 

Sillylttleone

Blue Cross and its covered at no cost. I use Enfamil Gentlease and get 12 cans a month for free.

noah80

I have individual blue family coverage how do I find out if I can get this?  We also use the Gentlease by Enfamil.