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Alimentum and insurance

libgomezlibgomez member
in Food Allergy
Has anyone had any sucess getting alimentum covered by their insurance? and if so how? I have blue cross blue shield and im starting the battle on monday and any advice/insight would be great, thanks!
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Re: Alimentum and insurance

  • magdusiamagdusia member

    my friend did.. not due to allergies, but due to reflux.

    she got denied and just kept fighting until they gave in. She pretty much said that she will have to take him to the ER all the time and that is much more expensive for the insurance than just paying for formula for a year. 

    good luck!

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  • libgomezlibgomez member
    Thank you so much! i may just have to be stubborn and do the same thing lol
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  • macaroni1979macaroni1979 member

    Yes! Very easily! And I have Carefirst. Start by calling a medical supply company. Blue Cross suggested Edgepark  https://www.edgepark.com/

    Call them. They will ask you questions, send your pedi forms to fill out about your LO and then your pedi will fax them to Edgepark. Edgepark sends all the necessary info to your insurance company and then lets you know in a few days if you were approved. For us, it was a very easy process. Edgepark sends me a case, 12 cans of Alimentum, overnight to our house. I pay a $40 copay to Carefirst for each case. Easy peasy! They have been covering it since Asher was 4 mo old, and still are! Not sure what reason your LO is on Alimentum, but Ash is allergic to dairy, soy, gluten, and pretty much everything else. Good luck and let me know if you have any questions! 

    Josie Cailin 7/25/08 Asher Mason 7/19/10
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  • tnd81tnd81
    I had Blue Shield at the time and they covered it no questions asked. My pedi nurse called it in to blue shield (DD had blood in her stool) and it wasn't long until cases were delivered to my front door. It's a great deal! I switched to Blue Cross when DD was about 10 mos old and their coverage wasn't as good, I had to pay $100 or so out of pocket. I had tons stocked up so I discontinued the service. She's 18 mos now and I still have cases of Alimentum in my garage... hoping and not hoping baby #2 can use it.
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  • mkeattsmkeatts member
    We has Aetna and were not able to get it covered. We got doctor's documentation, records of her Upper GI and ultrasounds and fought on many levels. They refused it. Aetna/express scriptssucks. I hope you have better luck and different insurance.
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  • junebride060306junebride060306 member
    my LO's alimentum was covered 100%. $0 copay. under BCBS for his MSPI. they gave us 11 cans a month (based on the prescription his pedi wrote for 40oz per day). however we just had to switch insurance to united healthcare and they will not pay for it no matter what. we are able to still fill it via prescription and pay full price but use our FSA for it, so at least it's pretax. good luck!
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  • abs05abs05 member
    We were able to get alimentum covered.  We have United Healthcare and on the advice of our pedi we just kept calling until they said yes.  It took 3 calls I think.  It was lovely having it mailed to our doorstep every month!  They covered 85 percent of the cost which was great.
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