Finding Coverage For The High Price Of A Feeding Disorder

I used to complain about the hefty price of $23 a can for Charlie’s specialty infant formula. We don’t qualify for WIC and I was told our insurance would not cover it. Until she was switched to another formula at nine months, I had to bite the bullet and pay out of pocket.

Just thinking about that first formula made me wince up until today. It was today that I found out the price of her latest medical food (formula is called medical food when children are no longer infants) and I thought I was going to be sick.

What is a mother to do when her child can not consume adequate nutrition through food but can not afford the doctor’s recommended alternative? There is no choice. I had to figure it out. I knew there had to be a way to get it covered. But, how?

First, I called Charlie’s primary insurance carrier. Sadly, each time I call Charlie’s insurance provider, I hope that the person answering will be friendly, helpful, and accommodating. Not this time. Not ever.

I got a smoke screen. The representative on the phone explained that our drug plan should cover it.

Next, I called Charlie’s prescription drug plan carrier. While I was invited to order the formula through the mail order pharmacy, I was told because it does not technically require a prescription to be dispensed it was not covered.

Afterwards, I called Charlie’s secondary insurance. This time, I was told Charlie’s doctor would have to call before they would even discuss coverage. The person was curt and would not provide any helpful details.

For a moment, I was frustrated and wanted to cry. However, I continued to hunt for a solution. During my search, I discovered many of the medical nutrition companies have pages on their websites that address insurance concerns such as the pages found here, here, here, and here. Apparently, I’m not the only parent who has faced or will face this problem.

I called one of the helplines offered off of a nutrition company’s website. The woman who answered was incredibly helpful in dealing with my insurance company. After an afternoon on the phone with Charlie’s insurance providers and waging a small battle, I found out it is possible to get medical food covered under the Durable Medical Equipment portion of the policies.

Charlie’s prescribing doctor needs to write a letter of medical necessity, supply the needed codes, and speak with the insurance providers. Things are now in his hands. There is a good chance the medical food will be covered.

For some time now, I’ve held on to the thought that the business side of our country’s health care system is shameful. I thought I had seen the worst of it ranging from the uncooperative and seemingly deceptive insurance companies to exorbitant pharmaceutical and equipment prices.

Today, my respect for our country’s health care system has reached a new low. I find it despicable that I’m excited by the slightest possibility I will be able to feed my child the nutrition she requires.

 

 

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About Rebecca Wood

In May 2012, my pregnancy ended three and a half months early due to severe early onset preeclampsia. This is my collection of thoughts and media. It is an attempt to document and discuss our experience of navigating the post NICU world. View all posts by Rebecca Wood

5 responses to “Finding Coverage For The High Price Of A Feeding Disorder

  • Saka

    Oh wow… That breaks my heart to know that you had to fight this… For nutrition!! But I’m glad you did. Being a preemie mom is already hard enough, I wish we didn’t have to deal with such things. Hopefuly it will work out. Even here in Canada, coverage varies from province to province… Unfortunately…

    Liked by 1 person

  • steevbeed

    We have just had a lengthy battle here in the Uk to get my sons nightime pads reinstated. We won, but now he has got used to not wearing them and refuses! It feels like you’re always fighting something or someone at times. Keep on keeping on!

    Liked by 1 person

  • Tracy

    We just switched insurance policies in March … and now my son’s $900/month formula is no longer covered … even though it’s his ONLY source of nutrition … and we are paying a hefty cost for the insurance policy … sigh. I’m going to look at the Nestle site you posted as we use Compleat Pediatric & have a high end plan with BCBS … Thanks, Obamacare, for making it all better (NOT!)

    Liked by 1 person

  • Laura Maikata

    I’ve always thought that babies with tubes got it covered as a durable medical expense. I’m glad you fought it out!

    Like

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