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So happy right now-Insurance covering formula :)

jaxlifejaxlife member
in Food Allergy
I am so happy I got a call today from Apria healthcare saying that They will ship a month supply of Alimentum RTF and my copay is only 20%. It was so easy, I just had to fax them a prescription for formula with a reason for it. I had called the insurance before and they told me it wasn't covered but I read on another board that if you go through a company they know how to bill it the right way. It's worth a shot for all you moms out there.
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Re: So happy right now-Insurance covering formula :)

  • sarajo317sarajo317
    Im waiting to hear back from the pharmacy to see if my daughters formula (Neocate) will be covered :( I have a feeling it isnt and I want to cry! What do you mean if you go through a company that knows how to bill? My insurance is BCBS of TX
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  • jaxlifejaxlife member
    I had called my ins (aetna) and they said it wasnt covered, then I dropped off a RX at the pharmacy-they said it wasnt covered. then i saw on another board that in most plans the formula coverage is under the medical coverage and not RX coverage. What I mean by company that knows how to bill is because the formula coverage is most likely under the medical coverage so the formula has to be billed to the ins company with the right coding. Thats where a medical company like apria healthcare comes in, they will look at your particular plan and see if its covered or not and if it is they will order the formula for you, mail it to your house every month and bill the ins company for it. My copay is 20% but some people dont even have acopay at all depending on their plan. Call apria healthcare (800) 277-4288, explain your situation and they will forward you to the right place (i think its enteral nutrition).
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  • livinrealitylivinreality member

    It really takes a lot of work and talking to the right person, so a company that deals with it regularly knows how to get the right answer.... 

    For ds1, My insurance covered it through durable medical equipment so I just had to meet my deductible than it was covered at 70%.... This was really hard to find out, it took multiple calls to the insurance company and asking for supervisors and finding someone who actually knew something... I spent hours on the phone.  

    However My insurance withds2 covers it through a prescription program. Again it took several calls and asking to talk yo supervisors to find t his out.  Neocate is actually covered under Rex and dme with our current insurance however it is free in the rx program and a 30% copay under dme.

    My pedi office was very helpful and our pedi gi is through a hos pital which has a insurance department whih helped me walk through the red tape, getting the right paperwork and wording to the insurance company.  The prescription had to be worded very precicisely.

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  • livinrealitylivinreality member

    imagejaxlife:
    I had called my ins (aetna) and they said it wasnt covered, then I dropped off a RX at the pharmacy-they said it wasnt covered. then i saw on another board that in most plans the formula coverage is under the medical coverage and not RX coverage. What I mean by company that knows how to bill is because the formula coverage is most likely under the medical coverage so the formula has to be billed to the ins company with the right coding. Thats where a medical company like apria healthcare comes in, they will look at your particular plan and see if its covered or not and if it is they will order the formula for you, mail it to your house every month and bill the ins company for it. My copay is 20% but some people dont even have acopay at all depending on their plan. Call apria healthcare (800) 277-4288, explain your situation and they will forward you to the right place (i think its enteral nutrition).

    Jaxlife how old is your lo? My youngest DS is 4.5 months... Noticed we are doing a lot of posting together :) 

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  • jaxlifejaxlife member
    My DS is also about 4.5 months. Born 05/04/12. He is mi 1st and boy, has it been something! He has reflux and at least that I know of MPI but I think he might have other food intolerances too. He is doing just fine right now :)
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  • 4girls+14girls+1

    imagesarajo317:
    Im waiting to hear back from the pharmacy to see if my daughters formula (Neocate) will be covered :( I have a feeling it isnt and I want to cry! What do you mean if you go through a company that knows how to bill? My insurance is BCBS of TX

     

    I am pretty sure that TX is one of the few states that have insurance laws requiring coverage. Make sure you doc uses the correct diagnosis (EOS, EE, food allergy, FTT, etc) when he writes the script.

     

    Good luck

    Angi (dd4 is a former Neocate, EO28 Splash kiddo who has EGE) 

    Mom to DD1 - almost 11 DD2 - 9 years old DD3 and DD4 - twins aged 7 Sea Monkey EDD 5/26/2013 Lilypie Maternity tickers
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