Pediasure coverage

[Guest guest]

Someone had questioned ins. covering Pediasure and thick-it. They will cover both, depending how the doctor words the scrip. The scrip should mention that the pediasure is for nutritional supplementation or is special nutrition for a metabolic disorder. The thick-it should mention it is to prevent aspiration pneumonia due to aspirating on thin liquids. I found out that insurance will cover most anything, it all depends on the wording.

DebsMom To (11/30/94-1/13/2001) Leigh'sand Greg (5/31/90) HealthyThe only thing in life that is certain, is this moment in time. Make the most of it!http://communities.msn.com/TheLloydsourjoysandtears

[Guest guest]

Diane, I'm assuming you already know this, but if you do not qualify for Medicaid because your income is too high, there is a "loophole" for people with disabled children, which means you qualify regardless of income. I think this is nationwide, not state mandated. I had to apply for, then be rejected, social security for my son, then apply for medicaid and it was accepted. It has been an unbelievable help as it covers nearly everything that my primary insurance does not, including co-payments for doctors visits. They also cover all meds.They cover our pediasure but it is put through the feeding tube. They have also paid for pre-thickened water and juice for my son which is wonderful because then you don't have to mix it, and it often gets too thick while you are getting everything else ready! Hope this helps somehow. , mom to Noah

[Guest guest]

Diane, I'm assuming you already know this, but if you do not qualify for Medicaid because your income is too high, there is a "loophole" for people with disabled children, which means you qualify regardless of income. I think this is nationwide, not state mandated. I had to apply for, then be rejected, social security for my son, then apply for medicaid and it was accepted. It has been an unbelievable help as it covers nearly everything that my primary insurance does not, including co-payments for doctors visits. They also cover all meds.They cover our pediasure but it is put through the feeding tube. They have also paid for pre-thickened water and juice for my son which is wonderful because then you don't have to mix it, and it often gets too thick while you are getting everything else ready! Hope this helps somehow. , mom to Noah

[Guest guest]

Diane, I'm assuming you already know this, but if you do not qualify for Medicaid because your income is too high, there is a "loophole" for people with disabled children, which means you qualify regardless of income. I think this is nationwide, not state mandated. I had to apply for, then be rejected, social security for my son, then apply for medicaid and it was accepted. It has been an unbelievable help as it covers nearly everything that my primary insurance does not, including co-payments for doctors visits. They also cover all meds.They cover our pediasure but it is put through the feeding tube. They have also paid for pre-thickened water and juice for my son which is wonderful because then you don't have to mix it, and it often gets too thick while you are getting everything else ready! Hope this helps somehow. , mom to Noah

[Guest guest]

I am not sure if this in every state, as every state has different programs,

but here in Michigan we have an insurance subsidy program called Children's

Special Health Care Services(CSHCH), formerly Crippled Children's of

Michigan. What this does is cover whatever insurance does not. I found out

about this thru her early intervention program, I think. CSHCS actually

covered some diagnostic testing before Chelsea had any coverage at all. What

they could not do was add her on for health care services until we had a more

specific diagnosis than hypotonia, (this was before we hear mito). This is

all run thru our county health dept.

I revieve monthly statements from her ins. and it appears that they cover

about 2/3 to 3/4 of her supplies, but I have never recieved any bills saying

I have to pay, so I believe that CSHCS covers the rest. It would seem

plausible that other states have similar programs.

e, Chlesea's mom(non-specific mito)

[Guest guest]

Although some form of this exists in every state (I think), the requirements

for getting in from state to state vary greatly. In Oregon for example,

your child has to be either so incredibly violent that he causes physical

injury to others and/or himself AND cause significant property damage.

Medically to qualify your child has to be on a vent or TPN. In Tennessee I

believe the only way to qualify for the waiver program is if your child is

mentally retarded. In some states the requirements are much more lenient

(and appropriate in my opinion than others.

Terri

>From: jimlis3@...

>Reply-To: Mito

>To: Mito

>Subject: Re: Re: Pediasure coverage

>Date: Wed, 16 Jan 2002 07:09:57 EST

>

>Diane, I'm assuming you already know this, but if you do not qualify for

>Medicaid because your income is too high, there is a " loophole " for people

>with disabled children, which means you qualify regardless of income. I

>think this is nationwide, not state mandated. I had to apply for, then be

>rejected, social security for my son, then apply for medicaid and it was

>accepted. It has been an unbelievable help as it covers nearly everything

>that my primary insurance does not, including co-payments for doctors

>visits.

> They also cover all meds.They cover our pediasure but it is put through

>the

>feeding tube. They have also paid for pre-thickened water and juice for my

>son which is wonderful because then you don't have to mix it, and it often

>gets too thick while you are getting everything else ready! Hope this

>helps

>somehow. , mom to Noah

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[Guest guest]

HI could you tell more about prethickened water and juice. where do you get it and do you need a script to get it on medicaid? thanks-karen

Re: Re: Pediasure coverage

Diane, I'm assuming you already know this, but if you do not qualify for Medicaid because your income is too high, there is a "loophole" for people with disabled children, which means you qualify regardless of income. I think this is nationwide, not state mandated. I had to apply for, then be rejected, social security for my son, then apply for medicaid and it was accepted. It has been an unbelievable help as it covers nearly everything that my primary insurance does not, including co-payments for doctors visits. They also cover all meds.They cover our pediasure but it is put through the feeding tube. They have also paid for pre-thickened water and juice for my son which is wonderful because then you don't have to mix it, and it often gets too thick while you are getting everything else ready! Hope this helps somehow. , mom to Noah Please contact mito-owner with any problems or questions.

[Guest guest]

,

Thanks for the reply. The waiver program that I'm aware of in IL is

called the Beckett Waiver/Option. I checked into this through

the DSCC office and unfortunantly, we don't qualify. In order to be

part of this waiver, the child must need nursing care on a regular

basis. They said that in order to qualify, you must show that your

child needs regular nursing care. They will then provide you with the

waiver as long as that care can be given at home instead of a

hospital setting.. I guess that they are trying to keep costs down by

keeping the children at home instead. From my understanding, the

Beckett Waiver is federal but administered at a state level. IL

also has a program called Family Assistance. It's a lottery type

program that will distribute funds for families with handicapped

children on a monthly basis. They have an application to fill out.

When funds are available to add more families into the program, they

draw names at random. The problem is that they haven't had funds

available for quite a few years so they haven't had the drawing to

add families into the program. What good is a program like this if

they are not able to implement it?! If anyone has any other info on

programs in IL, I'd greatly appreciate it. Thanks Diane- mom to

diagnsosed with Alpha Mannosidosis

> Diane, I'm assuming you already know this, but if you do not

qualify for

> Medicaid because your income is too high, there is a " loophole " for

people

> with disabled children, which means you qualify regardless of

income. I

> think this is nationwide, not state mandated. I had to apply for,

then be

> rejected, social security for my son, then apply for medicaid and

it was

> accepted. It has been an unbelievable help as it covers nearly

everything

> that my primary insurance does not, including co-payments for

doctors visits.

> They also cover all meds.They cover our pediasure but it is put

through the

> feeding tube. They have also paid for pre-thickened water and

juice for my

> son which is wonderful because then you don't have to mix it, and

it often

> gets too thick while you are getting everything else ready! Hope

this helps

> somehow. , mom to Noah

[Guest guest]

, it took a long time for my primary ins. to deny this in order for Medicaid to pick up the tab, and it took a long time for them to find a supplier, but they finally did and it really is a big help, just one less thing you have to do at home. It is called RESOURCE thickened water and juices like orange, apple and cranberry . They also have a vanilla flavored "shake". It is made by a company called Novartis, and their number is 1-. I seem to need a dr. script for everything, as well as a letter from the doctor explaining the medical necessity for it. She did a great job, though, describing the importance of having the proper thickness on a consistent basis, etc. They come is nectar and honey consistencies, by the way. Good luck, let me know if you need any more information.

[Guest guest]

Diane,

This may be a back door if you don't qualify through the front. In Minnesota the child qualifies based on developmental disabilities. Check with your Social Services office to see if any such help applies. , Zach, and Jess did based on their "autism and sensory" issues.

Deb

Re: Pediasure coverage

,Thanks for the reply. The waiver program that I'm aware of in IL is called the Beckett Waiver/Option. I checked into this through the DSCC office and unfortunantly, we don't qualify. In order to be part of this waiver, the child must need nursing care on a regular basis. They said that in order to qualify, you must show that your child needs regular nursing care. They will then provide you with the waiver as long as that care can be given at home instead of a hospital setting.. I guess that they are trying to keep costs down by keeping the children at home instead. From my understanding, the Beckett Waiver is federal but administered at a state level. IL also has a program called Family Assistance. It's a lottery type program that will distribute funds for families with handicapped children on a monthly basis. They have an application to fill out. When funds are available to add more families into the program, they draw names at random. The problem is that they haven't had funds available for quite a few years so they haven't had the drawing to add families into the program. What good is a program like this if they are not able to implement it?! If anyone has any other info on programs in IL, I'd greatly appreciate it. Thanks Diane- mom to diagnsosed with Alpha Mannosidosis> Diane, I'm assuming you already know this, but if you do not qualify for > Medicaid because your income is too high, there is a "loophole" for people > with disabled children, which means you qualify regardless of income. I > think this is nationwide, not state mandated. I had to apply for, then be > rejected, social security for my son, then apply for medicaid and it was > accepted. It has been an unbelievable help as it covers nearly everything > that my primary insurance does not, including co-payments for doctors visits. > They also cover all meds.They cover our pediasure but it is put through the > feeding tube. They have also paid for pre-thickened water and juice for my > son which is wonderful because then you don't have to mix it, and it often > gets too thick while you are getting everything else ready! Hope this helps > somehow. , mom to NoahPlease contact mito-owner with any problems or questions.

[Guest guest]

, thank you for yor help with this. im sure this will work great. i've already called them. do have another question,does this group have a chat rm. or something of the sort. i cant even find the group other than by e-mailing like this. im not dumb i just stay so rattled any more some days not sure if im coming or going and all i do is cry. well sorry to go on but it's been a really bad week. again thanks for the information. GOD BLESS YOU AND YOUR FAMILY KAREN

Re: Re: Pediasure coverage

, it took a long time for my primary ins. to deny this in order for Medicaid to pick up the tab, and it took a long time for them to find a supplier, but they finally did and it really is a big help, just one less thing you have to do at home. It is called RESOURCE thickened water and juices like orange, apple and cranberry . They also have a vanilla flavored "shake". It is made by a company called Novartis, and their number is 1-. I seem to need a dr. script for everything, as well as a letter from the doctor explaining the medical necessity for it. She did a great job, though, describing the importance of having the proper thickness on a consistent basis, etc. They come is nectar and honey consistencies, by the way. Good luck, let me know if you need any more information. Please contact mito-owner with any problems or questions.