Insurance Coverage

Re: Insurance Coverage

• fennyann member

  February 2013

  Im not sure what insurance you have but..have you tried having the doctor call and provide any kind of proof of medical necessity? Some insurance's will override, not all will. I only know because i work for one. Or you could appeal your benefits. Now, the appeals process can take quite some time.

  
  
  
  
  
  
  

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• buttaflai member

  February 2013

  MommaHen1984:

  LO has MSPI and is on Alimentum. I have spoken to our insurance company a few times and they WILL cover the formula after I meet this years deductible. The year just started so obviously I am nowhere even close to meeting it. apparently office visits don't count towards a deductible, only xrays, outpatient testing, labs, etc etc. I asked them what happens if we dont need any of that and we dont end up meeting the deductible? There has to be some way around this to get them to cover this. Has this happened to anyone else?

  gah! We're dealing with the same thing AND both the allergist and pediatrician labeled it as a medical necessity for DS to be on Neocate. If I find a way around it, I will share. 

  
  
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• imimahoney

  February 2013

  We thought we needed Elacare for medical necessity but were denied by insurance. We appealed, like 5 times, but kept getting denied. It sucked! Thankfully, we were able to stay on nurtamigen but still, so frustrating!!

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• LSU628 member

  February 2013

  I was also denied coverage for Elecare. Do you have separate pharmacy and medical insurance? The lady from the pharmacy insurance suggested I try my medical insurance. If I have luck I'll let you know.
  

  
  
  
  

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• pixiedustcan

  February 2013

  Check the law in your state. 

  LO is on Elecare, and when we first begun the process of finding a formula that worked the pedi kept issuing medican necessity to the insurance and they kept denying.  Elecare was perscribed by a pedi GI, also denied.  When I went in for the follow up he asked if the insurance gave me an trouble, as he knew we had trouble with other types in the past.  After about two months they covered it.  Turns out they cannot deny in Massachusetts if it is medical necessity and all it took was some work from the people who called it into our Insurance and bang it was covered.

  We would have spent anything on that formula to keep our LOs tummy at ease, having the insurance pick it up is just a giant blessing now we can take that $120 per can and put it toward something else for her..

  Fight them till you have no more fight!!! 

  

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• Fuzzy8252 member

  February 2013

  Is it being run through medical or prescription?

  We have ended up buying it out of pocket and sending in claim reimbursements, accompanied by a letter from the allergist, a letter from our case nurse with the insurance company and all the diagnostic and billing codes. EVERY.SINGLE.TIME.

  They put it toward our deductible. Occasionally they deny our claim, so we have to go through the hassel of calling them and explaining it. It just depends on who actually processes it.

  

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• puppycup

  February 2013

  Talk to your insurance about what your coverage is under necessary medical equipment. That is how my daughters elecare was covered completely. We also needed a prescription from our pedi. But the key was necessary medical equipment!!! Good luck

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