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b2b777
LIF Adult
Member since 9/09 4474 total posts
Name:
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HUGE THANK YOU - Ohbaby2!!! Specialty formula - insurance? - another question
***Thank you Ohbaby2 for generously donating tons of formula to us!!! Soooo generous!***
Has anyone got their insurance company to cover specialty formula like Alimentum? My little one has reflux and the doc said with his symptoms he likely also has a milk protein allergy. Wondering if anyone had success getting this covered.
Edited to add: does anyone know if there is a diff btw the RTF and powder? The Rtf is super smelly!!
Message edited 11/20/2016 6:13:08 PM.
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Posted 11/8/16 7:50 AM  |
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jamnmore
LIF Adult
Member since 6/16 989 total posts
Name:
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Specialty formula - insurance?
I was able to get a high calorie formula covered for my son years ago. I had to go through the pharmacy division of our insurance and had to get a script from the dr, but it was easy. I would pick up my script at CVS every month.
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| Posted 11/8/16 7:59 AM |
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AngnShaun
Sisters
Member since 1/10 21015 total posts
Name:
Ang
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Specialty formula - insurance?
Call your insurance and ask what they need from the Dr to cover it. Mine needed a letter from the dr explaining why.
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| Posted 11/8/16 9:33 AM |
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JDubs
different, not less
Member since 7/09 13160 total posts
Name:
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Re: Specialty formula - insurance?
It depends on insurance. My medical plan would not cover it, but my Rx plan is through my DH's union. They said they would pay half with a note of medical necessity from the doctor. I got a script from the doctor and filled it at a pharmacy (I got 5 cases of alimentum a month) and paid for half ,which came out to about $155 but it was better than paying over $300. My cousin's insurance covered it in full and she got the cases delivered to her at home.
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| Posted 11/8/16 10:02 AM |
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nraboni
Uggh...
Member since 10/09 6905 total posts
Name:
Nicole
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Re: Specialty formula - insurance?
Posted by AngnShaun
Call your insurance and ask what they need from the Dr to cover it. Mine needed a letter from the dr explaining why.
THIS!
Also, I had to speak to 3 or 4 people within my insurance company to finally get someone who knew and understood my plan and knew where to look to find the coverage.
Ask someone about Nutrition coverage and push until you talk to someone that can help you.
My DS was on Alimentum and it was delivered to the house by EdgePark. I paid a copay each month. I also had to have my doctor send a note to the insurance company and to EdgePark.
Good luck!
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| Posted 11/8/16 10:44 AM |
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jams92
Member since 1/12 6105 total posts
Name:
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Re: Specialty formula - insurance?
Yes, Aetna covered nutramigen for my son until he was 1. They only covered 80% of it, but it was better than nothing!
They way I needed to do it was purchase it from one of their authorized retailers (target, cvs and some others) and then submit the receipt with the doctors note and a medical form Aetna provided me via fax. They would then reimburse me with a check. It was a lonnng process and many times they claimed they never received the fax; it took a lot of following up. But in the end I got all my claims paid out.
I was told by others that some insurance will just send you the formula instead of reimbursing you.
Call them up and ask what their policy is
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| Posted 11/8/16 10:54 AM |
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b2b777
LIF Adult
Member since 9/09 4474 total posts
Name:
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Specialty formula - insurance?
Thanks everyone. Just started it today. Hope it helps my little one.
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| Posted 11/8/16 6:49 PM |
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LuckyStar
LIF Adult
Member since 7/14 7274 total posts
Name:
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Specialty formula - insurance?
Yes, we get 6 cases every month from Edgepark. My insurance covered everything.
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| Posted 11/8/16 8:55 PM |
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MrsO
Big Brothers to Be
Member since 1/07 4521 total posts
Name:
Maureen
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Re: Specialty formula - insurance? - another question
There really isn't supposed to be a difference between the rtf and the powder but I always preferred rtf
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| Posted 11/9/16 12:17 PM |
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JDubs
different, not less
Member since 7/09 13160 total posts
Name:
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Re: Specialty formula - insurance? - another question
Posted by MrsO
There really isn't supposed to be a difference between the rtf and the powder but I always preferred rtf
This
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| Posted 11/9/16 1:01 PM |
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b2b777
LIF Adult
Member since 9/09 4474 total posts
Name:
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Re: Specialty formula - insurance? - another question
Posted by JDubs
Posted by MrsO
There really isn't supposed to be a difference between the rtf and the powder but I always preferred rtf
This
This stuff makes me gag!! Hoping I get used to it. Littlw one also has reflux so it keeps coming up. Praying after a few days the reflux will improve too.
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| Posted 11/9/16 2:46 PM |
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jams92
Member since 1/12 6105 total posts
Name:
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Re: Specialty formula - insurance? - another question
Posted by b2b777
Edited to add: does anyone know if there is a diff btw the RTF and powder? The Rtf is super smelly!!
There is not supposed to be a difference. The powder still smells, but not as strong. I always would opt for powder though...I found it much easier. You could mix with room temperature water and not have to worry about warming up the bottle.
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| Posted 11/9/16 3:21 PM |
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mommy2be716
LIF Adult
Member since 1/16 2921 total posts
Name:
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Specialty formula - insurance? - another question
we are on alimentum covered by insurance right now. We use the powder because it's easier to travel with, and easier to pack away for daycare. We have the empire plan, and it covers 12 cans per month for $0.
ETA: We went to a GI (dr. daum in mineola), and they prescribed it for us. They place the order through continued care in huntington, and they contact insurance for you. Insurance will tell them what code they need in order to cover it. We needed the "milk allergy" code. Not sure if this helps at all
Message edited 11/12/2016 7:58:15 AM.
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| Posted 11/12/16 7:55 AM |
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b2b777
LIF Adult
Member since 9/09 4474 total posts
Name:
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Re: HUGE THANK YOU - Ohbaby3!!! Specialty formula - insurance? - another question
Bump
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| Posted 11/20/16 6:11 PM |
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OhBaby2
LIF Infant
Member since 1/15 309 total posts
Name:
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Re: HUGE THANK YOU - Ohbaby2!!! Specialty formula - insurance? - another question
You are so welcome!!! 
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| Posted 11/21/16 1:41 PM |
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