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Smileyd17
kids
Member since 5/05 20997 total posts
Name:
Mommy
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So I was denied (update)- ok, we may got somewhere
The formula for the boys, GHI will NOT cover it.
and the SOY formula has caused SEVERE constipation and are in pain, so that we cant use anymore.
ETA: I spoke to GHI, and i was pretty much like WHY??????????
LOL
stated that a ltr of medical necessity would not be denied and if I provide that, it shoud be ok.
Doc will be sending it and fingers crossed.
Message edited 10/14/2010 4:38:39 PM.
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Posted 10/14/10 4:04 PM  |
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poc53
LIF Infant
Member since 1/06 97 total posts
Name:
E and P
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Re: So I was denied!
elecare?
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| Posted 10/14/10 4:09 PM |
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TTCbaby
Twin mommies are twice as nice
Member since 4/08 1861 total posts
Name:
J
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Re: So I was denied!
What reason did they give you for not covering it??
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| Posted 10/14/10 4:11 PM |
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maymama
my little loves
Member since 8/08 18453 total posts
Name:
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Re: So I was denied!
Posted by poc53
elecare?
i would try elecare also. since it is NOT OTC, if your Ped will sign a medical necessity form, its harder for Insurance to deny 
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| Posted 10/14/10 4:11 PM |
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Smileyd17
kids
Member since 5/05 20997 total posts
Name:
Mommy
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Re: So I was denied!
Posted by TTCbaby
What reason did they give you for not covering it??
nothing outside of it just wont cover it, only it it was given through a feeding tube.
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| Posted 10/14/10 4:18 PM |
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TTCbaby
Twin mommies are twice as nice
Member since 4/08 1861 total posts
Name:
J
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Re: So I was denied!
Posted by Smileyd17
Posted by TTCbaby
What reason did they give you for not covering it??
nothing outside of it just wont cover it, only it it was given through a feeding tube.
ugh, that stinks...is there any sort of appeal process that you can go through? A letter of medical necessity the dr. can sign and send them? not just the script
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| Posted 10/14/10 4:19 PM |
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JoJo2010
Happy Family
Member since 8/09 6266 total posts
Name:
JO
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Re: So I was denied!
What about sensitive soy?
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| Posted 10/14/10 4:21 PM |
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Smileyd17
kids
Member since 5/05 20997 total posts
Name:
Mommy
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Re: So I was denied!
Posted by JoJo2010
What about sensitive soy?
Cant use soy
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| Posted 10/14/10 4:22 PM |
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Diana1215
Living on a prayer!!!
Member since 10/05 29450 total posts
Name:
Diana
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Re: So I was denied!
That really stinks Deb.
What are they on?
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| Posted 10/14/10 4:25 PM |
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JoJo2010
Happy Family
Member since 8/09 6266 total posts
Name:
JO
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Re: So I was denied!
Posted by Smileyd17
Posted by JoJo2010
What about sensitive soy?
Cant use soy
Because of the constipation? Maybe the sensitive will be better on the tummy
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| Posted 10/14/10 4:26 PM |
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Michelle
My Little Yankee Fans
Member since 1/06 4018 total posts
Name:
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Re: So I was denied!
When I called my insurance company they said it would not be covered unless thru a tube. I contacted Apria healthcare and they contacted the insurance and got it covered at 90%. I just needed a script and I got the alimentium RTF shipped directly to my door once a month.
I would try contacting them and see if they can get them to cover it.
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| Posted 10/14/10 4:26 PM |
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BAM 2009
I am who I am!!!
Member since 5/09 6081 total posts
Name:
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Re: So I was denied!
Have your Dr's office keep calling. Make sure they fax a letter to the company explaining why they need this formula. Also if you call Apria healthcare they can help you. Friends of mine had their Alumentim and Similac Sensitive covered using Apria. They did all the work...We would have used them, but our insurance didn't deal with them. We now use Landauer...Keep fighting it...What formula are they on?
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| Posted 10/14/10 4:28 PM |
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Smileyd17
kids
Member since 5/05 20997 total posts
Name:
Mommy
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Re: So I was denied!
Posted by JoJo2010
Because of the constipation? Maybe the sensitive will be better on the tummy
Yup, so constipated.
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| Posted 10/14/10 4:29 PM |
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HomeIsWithU
Baby #2 on the way!
Member since 9/07 7816 total posts
Name:
Jenn
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Re: So I was denied!
i went through this too. They told me they would not cover it unless it had to be given through a feeding tube.
I had my doctor call Apria directly and I also filed an appeal with my insurance company and had my doctor write a letter of medical necessity and send it to them. It took a lot of phone calls back and forth with the insurance company and they were still saying No. it wasn't until we got through to Apria that they were able to get it covered for us.
I believe, based on the research we did on the issue at the time, that in NYS it's actually illegal for insurance companies to deny coverage for prescription formulas.
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| Posted 10/14/10 4:34 PM |
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Diana1215
Living on a prayer!!!
Member since 10/05 29450 total posts
Name:
Diana
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Re: So I was denied!
Posted by Smileyd17
Posted by JoJo2010
Because of the constipation? Maybe the sensitive will be better on the tummy
Yup, so constipated.
are they on Alimentum?
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| Posted 10/14/10 4:36 PM |
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Michmouse
LIF Adult
Member since 11/07 1260 total posts
Name:
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Re: So I was denied (update)- ok, we may got somewhere
Where do you live? In NY insurance companies are mandated to cover enteral formulas 100%. (Elecare)
Are you seeing a GI? They know how to complete the paperwork process.
http://www.ins.state.ny.us/acrobat/ah_basichosgrp.pdf
Message edited 10/14/2010 4:47:10 PM.
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| Posted 10/14/10 4:45 PM |
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