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newmammahere
LIF Infant
Member since 6/09 188 total posts
Name:
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Insurance covered formula question?
For those whose insurance cover your child's formula, what formula is your child on?
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Posted 11/17/09 10:43 PM  |
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alisonggg
Cutie
Member since 3/06 4749 total posts
Name:
a
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Re: Insurance covered formula question?
Neocate
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| Posted 11/18/09 8:27 AM |
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jes81276
summer fun!
Member since 3/06 4962 total posts
Name:
Jaime
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Re: Insurance covered formula question?
he was on Alimentum
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| Posted 11/18/09 8:31 AM |
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Michmouse
LIF Adult
Member since 11/07 1260 total posts
Name:
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Re: Insurance covered formula question?
Elecare. I am pretty sure NYS mandate requires they cover 100% all prescription formula.
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| Posted 11/18/09 8:35 AM |
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MrsRbk
<3 <3 <3 <3
Member since 1/06 19197 total posts
Name:
Michelle
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Re: Insurance covered formula question?
Posted by Michmouse
Elecare. I am pretty sure NYS mandate requires they cover 100% all prescription formula.
it depends. I also live in a state where it's mandated, however it is all about how your company funds the insurance. Since the company I work for self funds the insurance they do not need to comply with the state mandate.
To answer the OPs question DD is on Alimentium, however my insurance while mandated they do so, does not cover it.
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| Posted 11/18/09 8:37 AM |
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babyfaith
Onward and Upward!
Member since 2/08 3210 total posts
Name:
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Re: Insurance covered formula question?
Similac Alimentum
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| Posted 11/18/09 8:56 AM |
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MEWF
LIF Adolescent
Member since 4/07 503 total posts
Name:
M
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Re: Insurance covered formula question?
never heard about a NYS mandate. had i needed special formula i would not have gotten it covered. its about your insurance plan and what documentation the dr gives for needing it. My friend needed it for her DD and her dr had to say without the formula the baby would be unable to eat anything else and starve. He had to use very strong wording—her life was endangered etc to get it covered.
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| Posted 11/18/09 9:04 AM |
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Maybe-baby
LIF Adolescent
Member since 12/07 774 total posts
Name:
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Re: Insurance covered formula question?
Similac Neosure
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| Posted 11/18/09 9:40 AM |
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DRMom
Two in Blue
Member since 5/05 20223 total posts
Name:
Melissa
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Re: Insurance covered formula question?
Nutramigen AA. I live in NC but my Dr wrote a letter and it was approved the same day. Just because it is not a "covered med" doesn't mean they won't cover it. Our only chice WAS the amino acid formula as my son still, at 11 months breaks out in hives if someone even touches him after drinking dairy. The cost was $1600 a month and our co-pay was $132. he was still miserable on BM even when I went totally dairy free.
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| Posted 11/18/09 9:49 AM |
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newmammahere
LIF Infant
Member since 6/09 188 total posts
Name:
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Re: Insurance covered formula question?
Would there be any chance that insurance would cover something like a 'regular' milk-based formula, or does it have to be for a special medical reason. (i.e. reflux, colic, dairy allergy, etc)
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| Posted 11/18/09 9:51 AM |
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Meggo613
im a big girl!
Member since 2/07 4536 total posts
Name:
Megan
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Re: Insurance covered formula question?
my dd has reflux and colicand an allergy shes on neutramigen and my insurace will NOT cover any formulas unless its needed through a feeding tube! 
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| Posted 11/18/09 10:22 AM |
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KateDevine
*
Member since 6/06 24950 total posts
Name:
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Re: Insurance covered formula question?
Posted by newmammahere
Would there be any chance that insurance would cover something like a 'regular' milk-based formula, or does it have to be for a special medical reason. (i.e. reflux, colic, dairy allergy, etc)
No. I don't think so.
DS was on Gentlease, which, while milk based isn't a standard formula and there was no way insurance would cover it
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| Posted 11/18/09 10:38 AM |
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Maybe-baby
LIF Adolescent
Member since 12/07 774 total posts
Name:
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Re: Insurance covered formula question?
Posted by newmammahere
Would there be any chance that insurance would cover something like a 'regular' milk-based formula, or does it have to be for a special medical reason. (i.e. reflux, colic, dairy allergy, etc)
I think there definately needs to be a medical reason. The acceptable medical reasons depend on th Insurance Company and your coverage. You probably can call to find out which are acceptable medical reasons based on your coverage. My Ped was already familiar with my insurance company and new what acceptable diagnosis would require them to cover the formula. DD was premature but that was not sufficient so the Ped also indicated that DD was high risk for rickets which was sufficient for my Insurance to cover the formula, which is milk-based. Also Apria Healthcare also has a form letter with generally accepted diagnosis listed for your ped to fill out. Apria can work through your insurance and Ped. to get the formula covered and delivered to your home. HTH.
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| Posted 11/18/09 10:47 AM |
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pinkandblue
Our family is complete, maybe
Member since 9/05 32436 total posts
Name:
Stephanie
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Re: Insurance covered formula question?
Posted by Meggo613
my dd has reflux and colicand an allergy shes on neutramigen and my insurace will NOT cover any formulas unless its needed through a feeding tube!
my insurance is the same (aetna)...good thing my ds is doing well on soy
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| Posted 11/18/09 10:48 AM |
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dm24angel
Happiness
Member since 5/05 34581 total posts
Name:
Donna
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Re: Insurance covered formula question?
Elecare
Theres a NYS mandate as some said that RX formulas ( amnio acid ones) must be covered, BUT NYS mandates only applyy to certainemployers, small employers, very large employers and unions do not need to follow NYS mandates b/c they determine their own benefits to their members, whereas the other companies follow the insurance companys guidelines.
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| Posted 11/18/09 8:33 PM |
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Hotmamma408
LIF Adolescent
Member since 6/08 692 total posts
Name:
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Re: Insurance covered formula question?
My DS is on Neutramigen (due to eczema from regular formula) and it is covered through my husband's union (FDNY) we have to go through CVS caremark and we pay a copay based on the amount of formula prescribed per month (ex: 32 oz a day is $86 /month and $36 oz a day was around $107/month)
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| Posted 11/18/09 9:03 PM |
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