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jdbaby
LIF Adolescent
Member since 4/11 660 total posts
Name:
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Getting Neocate approved by insurance
Does anyone have experience with this? Nutramigen didn't work and the dr is recommending this formula. But our insurance, Empire NYSHIP, will not approve. The formula costs a fortune.
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Posted 7/27/11 2:23 PM  |
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TwoGirls4Me
Treasure what you have
Member since 5/05 1839 total posts
Name:
Marie
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Re: Getting Neocate approved by insurance
We have the empire plan and ended up needing elecare for DD. We were lucky enough to get both alimentum and elecare covered. Did your pediatrician write a script for it and a letter of necessity? If that didnt work I have heard of contacting Apria, do a search on here, many people have success with them. I'm sorry you're going through this, its so stressful 
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| Posted 7/27/11 3:01 PM |
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tara73
carseat nerd
Member since 11/09 3669 total posts
Name:
Buttercup
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Re: Getting Neocate approved by insurance
NY law requires payment for formulas required by prescription if they have certain disorders. Your Dr should write a letter for you.
We have to get Neocate for DD2, this is from their website.
New York
Expand State
Collapse State
Bill name: Article 32 – Insurance Law
Effective date of the law: 1994
Your coverage:
* Insurance reimbursement for amino acid-based formula for the treatment of conditions that include, but are not limited to, inherited diseases of amino and organic acid metabolism, Crohn's disease, gastroesophageal reflux disease (GERD) with failure to thrive, disorders of gastrointestinal motility such as chronic intestinal pseudo-obstruction and multiple severe food allergies
http://www.ins.state.ny.us/ogco2001/rg105181.htm
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| Posted 7/27/11 3:38 PM |
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jdbaby
LIF Adolescent
Member since 4/11 660 total posts
Name:
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Re: Getting Neocate approved by insurance
Thank you guys so much. I'm surprised my dr office didn't know more about getting it approved through my insurance. Medco just said no and that there was no appeal. I decided to call and ask why it is not approved if there is a medical need. I spoke to a nice person on the United Health Care line who directed me to homecare advocacy for formula benefits. They are faxing my doctor a form and it sounded much more positive.
Thanks again for your feedback. This is so stressful!
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| Posted 7/27/11 3:42 PM |
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jdbaby
LIF Adolescent
Member since 4/11 660 total posts
Name:
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Re: Getting Neocate approved by insurance
They are also sending him to a gastro doctor to rule out anything else and possibly to support documentating the need
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| Posted 7/27/11 3:51 PM |
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jdbaby
LIF Adolescent
Member since 4/11 660 total posts
Name:
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Re: Getting Neocate approved by insurance
Just in case anyone else needs the info also ....i guess my iniital try at calling Medco (the prescription benefit part of Empire NYSHIP) was incorrect. When I called United Health Care about my benefits and they directed me to HomecareAdvocacy (HCAP), my doctor just had to call them directly to state the medical need and it was approved in several minutes!
We then had choices of 3 medical supply companies to have it delievered.
This stuff is like a maze sometimes, trying to figure it out. But I am relieved it is covered.
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| Posted 7/27/11 8:24 PM |
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lilangel919
LIF Infant
Member since 10/09 220 total posts
Name:
Vi
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Re: Getting Neocate approved by insurance
-I have empire too. They gave me the run around at first but then covered it. The letter from your doctor MUST state that this formula is your childs sole source of nutrition due to _____ medical condition.
Once approved Continued Care delivered as many cases to my house monthly as I needed.
The # and options I called where:
1-877-769-7447
Option 1 for united health care
Then option 3 for Benefits management program
Hope this helps!!
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| Posted 7/27/11 10:42 PM |
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