Getting Formula Covered by Insurance.....

[Guest guest]

I have a friend who has a 2 year old with mitochondrial

disease and eosinophilic disease….Her son drinks Ellecare Formula ( like

neocate)..

To the tune of $ 1,000 plus dollars a month that insurance wont

cover. Any input on getting private insurance companies to cover this would

be great. We live in AZ.

Thanks in advance…

Suzanne man, mom to Zoe

www.specialneedsmom.com

(check out my blog!)

[Guest guest]

Suzanne,

I don't know their financial situation, but we're on pediasure, ( not the same), WIC pays for ours up to age 5, but there are income restrictions. If this might be

a consideration you can email me for more info.

Lois

Getting Formula Covered by Insurance.....

I have a friend who has a 2 year old with mitochondrial disease and eosinophilic disease….Her son drinks Ellecare Formula ( like neocate)..

To the tune of $ 1,000 plus dollars a month that insurance wont cover. Any input on getting private insurance companies to cover this would be great. We live in AZ.

Thanks in advance…

Suzanne man, mom to Zoe

www.specialneedsmom.com (check out my blog!)

Please contact mito-owner with any problems or questions.

[Guest guest]

I am guessing their income is probably too

high- but obviously spending 1000 a month, there is not tons left over. I will

look into it thanks…

From: Mito [mailto:Mito ]

On Behalf Of lois saunders

Sent: Wednesday, April 27, 2005

4:28 PM

To: Mito

Subject: RE: Getting Formula Covered by

Insurance.....

Suzanne,

I don't know their financial situation, but

we're on pediasure, ( not the same), WIC pays for ours up to age 5, but there

are income restrictions. If this might be

a consideration you can email me for more

info.

Lois

Getting Formula Covered by

Insurance.....

I have a friend who has a 2 year old with mitochondrial

disease and eosinophilic disease.Her son drinks Ellecare Formula ( like

neocate)..

To the tune of $ 1,000 plus dollars a month that insurance

wont cover. Any input on getting private insurance companies to cover this

would be great. We live in AZ.

Thanks in advance

Suzanne man, mom to Zoe

www.specialneedsmom.com

(check out my blog!)

Please

contact mito-owner with any problems or questions.

Please

contact mito-owner with any problems or questions.

[Guest guest]

Suzanne,

I would also recommend contacting WIC. Sometimes Income is not the

only qualifier, for awhile both of my kids continued to be on it

because of their weight percentile. Both were in the 99th and then

kids that are really small also can be ok even if the income is off a

little.

The other thing i would recommend is have them talk to the Drs office

and have the Dr talk to the Formula rep. They may be able to get a few

free cans here and there, probably not enough to get by on but maybe

enough to help some. I know by getting to know the Rep my mom was able

to get us a case a month of Elecare back when my son was trying it.

YOu can also talk directly to the compnay and they may have some

programs to help out.

We were told that the only way to get it covered was to have a G-tube

and then it is still usually a fight. The reasoning was that they

don't have to pay for other food for kids why should they cover this

kind of Formula. Doesn't make sense to me but most of the things that

insurance says doesn't make much sense.

Hope that helps some,

J

Colo

Mom to Will (9/7/2001) Seizures, Migraines, Ataxia, Dysphagia,

Broncho/laryngeal/tracheal malacia, Asthma/Reactive Airway, Reflux

(despite Nissen Fundoplication), Delayed gastric emptying, Chronic

Constipation, Hypotonic Trunk, Hypertonic Extremities, Food allergies

(unknown to what), PDD. Suspected Mito/Metabolic issue, 2 negative

muscle biopsies, really weird labs, Heat Intolerance.

[Guest guest]

We had a harder time getting Gracie's Neocate paid for, since she did not have a g tube at the time. Usually the states medical waivier, or Medicaid will pay with a letter of medical necessity. Also WIC will pay for it as well, also with a letter of medical necessity. With Grace they even made special considerations with income because the cost of her food would cause a financial hardship. Our local WIC office went as far as, scheduling Gracies appointments when the office would not be busy and they made sure we got in and out as fast as possible to avoid having to be around so many people.

Best wishes

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[Guest guest]

HI Suzanne, you just have to wonder what a parent has to do to get

thier insurance companies to pay anything, but your friend with the 2

year old child does have mito, did a Gi specialist or neuro or GP put

the child on that formula??? If they did or if they didnt they can

get one of those docs to write a letter of medical nessecity as the

child is (mito)-medically fragile and needs this formula for this

disease as to keep from failure to thrive. Worth giving it a try. Doc

should also give a statement of mito because we all know how well know

this disease is. Hope this helps your friend. Barb