If you use Elecare or Neocate and your insurance does NOT cover it

How much does it cost?

Looks like this is our next step as per the Ped, but our insurance considers it an "over-the-counter" drug and does not cover it. I've heard its very expensive Anyone care to share what it costs?

Re: If you use Elecare or Neocate and your insurance does NOT cover it

I'm not sure yet what it costs. So far I've gotten samples from the GI specialist. But it clearly says on the can of Elecare "prescription only".

Have you seen a GI guy? What other formulas have you tried? Why are they recommending Elecare or Neocate? Can the GI doc write a letter of medical necessity? You can always try to appeal the insurance company's decision not to cover it.

Good luck.

Re: If you use Elecare or Neocate and your insurance does NOT cover it

My DH went online today and found out for 6 small cans was 215$ I heard its 50$ a can and you can only order it online.

We find out tuesday if our insurance will cover it or not. Right now we are using sample cans. THANK GOD my ped gave me a few cans to last us till tuesday cause if they don't cover it we will be order the 6 cans for 215$

We see a GI doctor on weds and I'm hoping they don't switch her formula after all this hassel to try and get it covered. My PED had to call my insurance company to tell them its a medical reason why she's on it(milk protein allergry). The insurance company told me most likely they will cover it cause its an allergy. My DH did a ton of research today and was told it can only be ordered online through Elecare and no store sells it.

Good luck and hope your insurance covers it for you

Re: If you use Elecare or Neocate and your insurance does NOT cover it

My DS is on Elecare. You have to fight for the insurance company to cover this formula. My insurance is Oxford and what happened was that my gastro doc. wrote a letter of medical necessity to the insurance company. It took a couple of weeks for the letter to be done and for it to go through. In the meantime, the doctor gave me a couple of sample cans and I ordered the formula directly from the website.

The only way to get this formula is through the web or from the pharmacy. After I got the formula from the web i mailed in my receipt and after a small battle with the the insurance comapny I even received the $400 dollars I spent on those 2 cases of formula i ordered directly from the site. Now, I get it from teh pharmacy and only pay a $50 copay for the month(which is about 12 or so cans).

They DO NOT stock this formula in the pharmacy so they ahve to order it and it takes like 2 days to come in.

You have to fight this with your insurance company because is the only source of nutrition your DS will have. This formula is crazy expensive. What insurance to you have??? If you have any questions FM me.

Re: If you use Elecare or Neocate and your insurance does NOT cover it

We paid as much as 55 dollars a can at the pharmacy in emergencies, or as little as 25 a can when buying it off ebay. We really bled through our savings that first year buying this formula. You can get it by the case from their website, too, and it's not too bad, as far as prescription formula goes.

ETA: I also want to add that just because you fight the ins. company does not mean it will be covered. If your insurance is private, they do not have to cover the formula for you. So many people here had success with apria helping them, when we called them, they spent like three weeks trying from every angle to get our ins. company to cover it, but because my husband's company chose to have private insurance, they did not have to cover it. It cost us approximately $500-600 a month for this formula and our insurance company could have cared less that our daughter had nothing else to eat.

Message edited 9/11/2009 7:00:44 AM.

Re: If you use Elecare or Neocate and your insurance does NOT cover it

We had to fight it and after a few weeks we got it covered, if we didnt we would have went into debt trying to feed our child. A month supply I was quoted $600.

Re: If you use Elecare or Neocate and your insurance does NOT cover it

I am so thankful that my ins. covers it. I know it is $50 a can. My ins. company gave me some names of places that wefre in network that have it delivered to my house. About 10 cases get delivered to my house each month for my 2 boys. I have the empire united healthcare plan. We use continued care to deliver our formula. My GI doc wrote the pres.

Re: If you use Elecare or Neocate and your insurance does NOT cover it

Go through Apria. They will help you.