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Elecare & DME supplier in Western PA? (or online)

MommyRN1MommyRN1
in Food Allergy

My 1 month old daughter is on Elecare formula for a milk protein allergy.  After 3 weeks of going rounds with Highmark BC/BS we got 100% coverage.  However, when we have tried to order it thru a DME (durable medical equipment supplier) (it's covered under medical not pharmaceutical) they decline the order.  What I found out is that they have never/rarely ever ordered it.  Therefore, when they negotiated with the insurance company, they didn't pay attention to the reimbursement rate.  The ins company with only pay them about $12/can & it costs $34+/can.  I was even told that the loss is too much for them to write off. 

 So, now that we have insurance approval, we can't find any place to order it.  Does anyone know of anywhere that they have used in the Western PA area?  Or an online DME that could/would order it?

(We don't qualify for WIC & now that the insurance technically approved the claim, we don't qualify for the patient assistance thru the manufacturer)

Any help is appreciated. 

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Re: Elecare & DME supplier in Western PA? (or online)

  • faith194faith194
    We get ours through Walmart(Pharmacy).  It costs us 10 bucks for a month's supply(BC/BS).  Is that an option, or am I missing something in your post?
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  • MommyRN1MommyRN1

    imagefaith194:
    We get ours through Walmart(Pharmacy).  It costs us 10 bucks for a month's supply(BC/BS).  Is that an option, or am I missing something in your post?

     

    Do you know if they're billing under your pharmacy benefits or under your medical benefits?  I will call and ask if they can do it, worth a shot. 

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  • panicked228panicked228 member
    What part of Western PA are you looking at? I've got some contacts all over the western part of the state.
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  • Fuzzy8252Fuzzy8252 member
    We've went around and around with our insurance, who won't and "can't" cover Elecare under our pharmacy plan, so everything is billed through our medical. We ended up just buying it online directly from Abbott Labs, and then sending a claim into our insurance company.
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  • MommyRN1MommyRN1

    imagepanicked228:
    What part of Western PA are you looking at? I've got some contacts all over the western part of the state.

     We are about 1 hour directly North of Pittsburgh & 1 hour directly South of Erie.  & we'd really be willing to go just about anywhere to get it.  Any help would be amazing! TY

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  • MommyRN1MommyRN1
    imageMommyRN1:

    imagefaith194:
    We get ours through Walmart(Pharmacy).  It costs us 10 bucks for a month's supply(BC/BS).  Is that an option, or am I missing something in your post?

     

    Do you know if they're billing under your pharmacy benefits or under your medical benefits?  I will call and ask if they can do it, worth a shot. 

    I called our Walmart and they can't bill under the medical benefits.

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  • M&M227M&M227
    At first I was told that Alimentum was covered under my medical benefits, but after talking to several people at the insurance company was told it was covered under my pharmacy benefits.  I go to the pharmacy and they order my cases.
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  • panicked228panicked228 member

    I don't have contacts around you. However, I have a few suggestions.

    1. Call Highmark. See who they usually work with. They should have a list of companies that accept their reimbursement rate.

    2. Call the WIC office, explain that you are not looking for formula from them, just a list of contacts. They should be able to tell you who to go through.

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  • Fuzzy8252Fuzzy8252 member
    Just an FYI... most pharmacies can't or won't bill to medical, only Rx coverage.
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