We have had great luck with Hannah drinking her Compleat Pediatric formula in her bottle along. The 4-oz formula, 4-oz whole milk or juice, and stage 2 fruit/vegetable combination has been quite successful. Based on this meal plan at 5 bottles a day, we would use about 75 cans a month.
Unfortunately, our insurance will NOT cover this formula for us. Why? Because Hannah does not have a G-tube or a pump. They would cover it if it was used in a feeding tube but NOT if it is taken by mouth. How stupid is that?!
Cost of 75 cans a month? About $225 a month ($75 for 24 cans)! That is just for the formula!
Fortunately, a mom I have recently befriended gave us about 12 or so cans that her son was no longer able to use, so we have been able to give her the formula. However, we are down to our last 3 cans (we have been using about 1 can a day).
Since our Medicaid application was never sent in, we don’t have medicaid yet even though we completed the nursing home visit. So I am HOPING once that our Medicaid is approved, they will cover the formula cost.
Until then, we just have to suck it up and pay for it. By the time we get to an appeal with the insurance company, we will hopefully already be on Medicaid.
Do you have an insurance case manager? We initially had the same problem with lucien’s formula ($1000/month), but were able to get a medical necessity waiver. Good luck getting medicaid processed!
It is so sad that if we don’t pay our monthly premiums, we are cancelled almost immediately but when we need the insurance companies, we face hurdle after hurdle.
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For the past month I saved Bertrand’s empty formula cans to start seeds in. After your post, I looked at the stack of cans a bit differently: 30 days, 15 cans, $360 total. Ouch. I need to bite the bullet and argue with our insurance over it. Sigh. After I turn in B’s medicare app. And do taxes. *Shudder*
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Call the insurance company and talk to an agent who can tell you exactly why the claim was denied. Sometimes it as easy as bad wording on the forms the doctor’s office sent in and it can be as easy as speaking to an agent yourself to fix it. Even if that is not the case, the agent can still re-open the case and the insurance company can look it over again.
The rationale of insurance companies always escapes me. Makes me wonder if actual human beings were sitting down at the table when they came up with these rules….if you haven’t re-petitioned them, I would. Then I’d do it again. If you have a caseworker through your insurance, they could be of assistance as well. If you don’t, I would encourage that as well.
Seriously…what are they thinking!?!?!
I hope something comes through for you soon.
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