Insurance coverage for reflux?

Re: Insurance coverage for reflux?

• PharmDMom member

  February 2015

  Im guessing you won't check this because you posted this almost three weeks ago but after appealing twice, we got three measly cans per month of Elecare infant approved for our DS when he was 5 months old. Still had to pay out of pocket for the other 6 per month that he needed. He had severe reflux and ended up with an NG tube because of the oral aversion he developed which made him stop eating altogether. If you want more info, PM me.

  

  
  

  
  
  

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• ladylisalt member

  February 2015

  omgosh! Sounds horrible. I was thinking of appealing but honestly didnt feel like filling out all of the paperwork knowing it most likely was going to get denied again. Insurance companies are ridiculous!  You may so much monthly for your whole life and they can't approve something for such a short time. My DD is 5 mos. so I felt like at this point I might as well keep paying. So sorry your son had it so severe, I can't imagine. I hope he is doing better.

  

  
  

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• PharmDMom member

  February 2015

  Glad you got my reply! Yes, he is doing better. He had the feeding tube for 4 months then through medication and behavioral therapy through our hospital's feeding clinic, we were able to get the tube out. He still has some feeding issues but is growing well now.
  
  It is a HUGE hassle to deal with all the insurance crap to try to get formula covered. And almost all the time, it ends up denied. I think we only got it covered bc when DS was admitted and got the NG tube, they gave him a failure to thrive diagnosis. Now that diagnosis didn't last long but that may have been the whole reason they approved the three cans per month. Unless your LO has severe reflux needing more than just a certain formula/some meds OR has multiple other medical conditions, it's unlikely your insurance will approve the formula. like you said, it is a short time (in the grand scheme of life) that they need formula so we moms can try to keep that in mind while shelling out the $$$ for 12 months!

  

  
  

  
  
  

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