Formula covered by Insurance

[Charmed7up]

Hi everyone,

I have a friend that is having issues with her dr and insurance company. They are trying to get a formula covered by insurance because her son is having severe issues with the regular formulas, but the doctor only put "colic" as the diagnosis and so the insurance company declined.

Has anyone fought this battle? I told her she needs to figure out which diagnosis will get the formula approved, but the insurance company is giving her the run around and she doesn't have that type of personality that will get the job done.

Any help would be appreciated!

[Mipsy]

Do they qualify for WIC?

[karamille]

WIC is a much easier way to go in getting it covered.  For formula to be covered by medical insurance (and even this doesn't always work) it needs to be for food allergies or some other GI problem.  Colic isn't really recognised as a "true medical condition" and it only lasts a few months, according to medical experts.  Now if dr finds blood in the baby's stool, or the GI doc scopes the baby, or if an allergist finds a food allgery, she has a much better chance of getting it covered.  And generally they will only cover the Rx elemental formulas.   

[zolanmel]

If he is on a special needs formula like Elecare (amino acid based)  all they need is a  prescription that says Why he needs it not just colic but like a allergy ,failure to thrive,eating problems .and take it to WIC . WIC covers special needs formula.

 

but also "colic" is not a reason for special formula so no the insurnace wont cover they need a actual diagnoses.

[Charmed7up]

I asked her if she tried WIC and she said she doesn't qualify b/c of their income. I'll mention the allergy issue since I think that is what it is. Thanks!