LEB

I have a 7 month old with milk and soy allergy with a anaphylaxis reaction when given a milk product (one ounce of regular infant formula mixed with breast milk is how we found out at 3 months). She has been prescribed neocate infant formula by her allergist and doctor. My insurance company denied the claim for coverage of the neocate, then after submitting letters from both doctors they denied the claim a second time stating that while they agreed the formula was medically appropriate it was not covered by our plan. No food products will be covered unless administered through a feeding tube. Had anyone dealt with this? Any suggestions on other information I should be submitting to my insurance company to get coverage other than letters of medical necessity that I have already submitted? Any help would be appreciated.

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bdmd

I am a family doctor, and although I have not dealt with prior authorizations on neocate before, I have had to deal with that obstacle on multiple other treatments. I would recommend you urge both of your doctors to call the insurance company directly and speak with their medical director about your case. It certainly will not hurt, and you would be surprised at how much more effective a phone call is than a letter. I have on numerous occassions had the insurance company deny an appeal in writing, only to have them grant the approval after a phone call by me. A lot of times, the insurance companies are just trying to see "how bad" your doctors want the patient to have the treatment. If your doctors will not do this for you, then I suggest finding new one(s); they should be willing to "go that extra step."

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Heather Shepherd

I found help through the W.I.C. program. It depends on your income. Without them I could not afford to feed my child. Worth looking into!

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Brittany Chlamon

Hey..I wonder why my doctor didn't put my baby on this formula..Instead he put her on Nutramigen?? and prevacid..And since this change she has had diarrhea which is supposed to be normal b/c it's supposed to make baby's stools more loose and she's been throwing up more..It seems like she's wanting to throw up and she's not lettting it come up. her regular doctor is kinda upset that that's all the gastro dr. did....Does anyone have anything helpful to say.?? please

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LEB

Brittany- I can't speak to your child specifically, but her is what happened with mine.,,
after my daughters allergic reaction I was told to stop nursing her for 24-48 hours to clear my system of any possible allergins. The doctor in the ER told me to give her Nutramigen during that time. My daughter did not take it well, hardly at all and was still getting sick. She was tested a few day later by a pediatric allergist and found to have a milk and soy allergy (that is all they tested for at that point.. she will be retested for other things next month). The allergist told me to NOT use nutramigen that for kids who have an actually Milk allergy (not just an intollerance) they may still have a reaction to the milk proteins in Nutramigen. Nutramigen still contains milk proteins they are just broken down so they should be easier for most kids to digest, but some still have a reaction or intollerance to it. So, I didn't use it after that. I was on a restricted diet and nursed her till she was over 7 months and now have her on the neocate. I must say that my pediatrian's office and the ER doctor both agreed that Nutramigen was the thing to give her but the allergist did not agree and my daughter has tollerated the Neocate very well. Hope that helps.

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rebecca dubois

My pediatrician sent a letter to my insurance company about covering neocate and they did not respond. She then called and I'm unsure about what was said exactly but we found out that the formula was actually covered under the medical supplies and once we reached our yearly deductable of 300 which we all know only takes two cases and a can or two depending on where you get the formula, the insurance company would cover 85% of the forumla there after until the next year. We just need to submit a claims form from the insurance company website with all the receipts. It takes about a month but they will send us a refund check. We have yet to do this simply because we just found out about it and we are waiting till we have a few more receipts before sending them in. It's worth looking into it even yourself as the parent. You may not even need to go through your pediatrican to get the answers you want.

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Nicole Gamble

We are also trying to get our insurance company to cover Neocate. Our 4 month old has a milk/soy allergy and could not tolerate nutramigen either. We initially go a denial and are waiting for an answer on our appeal. It is so frustrating as you all know how expensive this formula is. I like the idea about having our pediatrician call the insurance company. Thanks!

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Trisha McKinnon

When my daughter was 5 months old we were told she had ezesma but after things sporatically improving & then not improving I persisted & at 7 mos old we found out she has food/pet allergies. She is allergic to milk/soy/wheat/egg/peanuts/dogs/cats. Our allergist sent a pre-auth to HealthPartners & they approved her Neocate until she is 5 yrs. She is now 1.5 yrs old. Her condition has greatly improved as long as the other items aren't in her system or pet hair/dander around her (which is hard @ daycare)

sophiebug@cutey.com

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jill pelletier

Hello, Just wanted to say to all who are having a hard time with your insurance. Do not let them off the hook. I went through this with my daughter who is now 7 and still has multiple food allergies. She was on Neocate until she was over 3 and would still be if I could get her to drink it. Get your doctor involved.
Keep appealing and calling asking what they need to cover it? Who you need to talk to? What are there specific medical policies on this and what you need for individual consideration for your child?
DON' T GIVE UP!! I know the frustration. Take Care all!!!

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gwen altman

I have just been denied coverage of Neocate through United Health. They have also denied my appeal despite a letter from our pediatritian citing the details of why it was a medical necessity. I have been on the phone with the rep stating what a disgrace this is. I asked them to please let me know what they recommend? We know there is no generic substitue! Also, if we can't afford our Neocate and put him on something he is allergic to at lease we know his subsequent hosptialization will be covered! So much for preventitive medicice. Seems like is should be called United Health Doesn't Care.

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