Infantreflux.org | neocate insurance issues!!!

This topic has 5 replies, 1 voice, and was last updated 19 years, 6 months ago by Anonymous.

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April 3, 2007 at 6:31 pm #29435

Anonymous
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Hello all,

Everyone has been so helpful with all of my other questions, I thought I would pose this one…..
We do not qualify for any assistance with Neocate, I am currently paying $30.79 a can and I use about a can every 2 1/2 days.

I gave up on my insurance company pretty quickly (BCBS of Nebraska) basically because I work in the medical field and I know all about the appeals process and frankly I would rather pay out the money than talk to some of them!! They are frankly sooooooooo stupid I won’t waste my time!!!

BUT….. Now that I have read some of the postings here, I’m a little more calm, and ready to try again.

My son had a feeding tube for 8 weeks, was in the hospital, etc, etc… So I know now that it probably would have qualified to be covered then, but I was getting no sleep, and was sooooo exhausted from all the work of trying to feed the child that I didn’t even try.

To make a long story even longer, I would take any suggestions, wording, sample letters, etc that got approved or helped you get through to your insurance (especially if it is a blue cross blue shield policy)…….

My e-mail address is ericaanderson@alltel.net.

Sorry for the negative post, but I have had the worst time with this ins.co, I just could scream. Apparently, they would rather pay for my child’s MRI, upper GI, Echocardiogram, chest x-rays, e-room visits, hospital stay, feeding tube pump and supplies, and home health, all of which we’ve had done, but not simply the formula that could have prevented a lot of this……..

UGH!!!!!

Thanks in advance for all your input!

Erica

April 3, 2007 at 6:38 pm #29436

Anonymous
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i have been through this. in fact, i am still going though this wiht the prevacid.

as for the neocate, i would state all of the things that will happen if your child does not receive it, and what they will have to pay for in that case, which will be even more expensive (like hospitilzations, etc). you can talk about how if a child is mspi and does not recieve neocate when it is needed, that the other formulas will actually damage the GI tract and cause complications with the acid reflux. i dont know if you read the article “misconceptions on neocate and elecare” or something like that, but that is where i got all of my good info from.

here is the link to that article:

https://www.infantreflux.org/forum/forum_posts.asp?TID=6013&a mp;a mp;KW=misconceptions

also have your doctor write a letter of medical necessity, that letter is more important than your letter.

nataliachick72007-4-3 18:38:51

April 3, 2007 at 7:58 pm #29439

Anonymous
Inactive

Erica: We fought two insurance companies (husband changed jobs) and after medical letters of necessity and appeals processes – we were still denied. It is considered a formula. Well, IT IS, but it was the ONLY STINKING THING HE COULD TOLERATE. I know what you are going through.

We found that Children’s Miracle Network would give us $500 per year and we used that at our HyVee for Neocate ($29.99). We haven’t found any other organizations that will help. If your child is ever being tube fed again, I would apply then with your insurance and just forget to tell them that you are not tube feeding when you are done. These insurance companies just don’t get it. Sioux Valley Health Plan told us that if Neocate would ONLY send Neocate to people who had prescriptions, THEN they would start covering it, but it is sold over the counter at many grocery stores and is sitting right beside the other formula and is just formula. JUST FORMULA. We do get samples from Dr Neidich at Sanford Health when we go. He is good to pass them out. Good luck.

We have spent A LOT of money from our savings. Carson is 21 months and Dr Neidich says he will prob be on it until he is 3 years old. I am hoping that at 2 we can do something different but I don’t know what that would be. He is gaining now so I don’t want to upset the good gastric juices! Good luck. I do know what you are going through. I fought hard to get the Neocate covered and – No Luck for us.

April 3, 2007 at 8:09 pm #29443

Anonymous
Inactive

Some people have found that going through Apria Healthcare seems to help. It’s almost like the insurance companies will fight you to ridiculous lengths, but they don’t fight this company as much. We were in the process of getting them to fight for neocate with Alex when we decided that it really wasn’t helping her.

April 5, 2007 at 4:09 pm #29643

hellbennt
Keymaster

I’m guessing you looked here?

Going to the Top: https://www.infantreflux.org/forum/forum_posts.asp?TID=2607&a mp;a mp;KW=going

April 12, 2007 at 9:36 pm #30328

Anonymous
Inactive

As someone else mentioned, I’d try Apria Healthcare. My dr wrote a prescription for the Neocate and faxed it to Apria (eventhough the dr said the rx probably wouldn’t help get it covered). Apria then handled the whole thing with the insurance, it’s covered 100% and it’s delivered to us monthly!
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