Re: Elemental Insurance Question
Our son who has officially been labeled "universal ulcerative colitis-indeterminite" and "failure to thrive" was started on exclusive elemental formula via NG tube. The formula was ordered by our doctor and social worker coordinated it all to be delivered to our house from a home health company. I'm pretty sure he had ensure and splash covered before this though as a supplement. One of the keys i think is to get your doctor to order it. He now uses 5-6 cans per day through a G-tube---we could never afford it on our own. We know how lucky we are that his dual coverage covers him.
Have you tried insurance and been turned down?Great that it is helping your son!
Laura (max 4 IBD)
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Re: Elemental Insurance Question
Glad that it seems to be working already! We have gotten our insurers to pay for the peptamen, but have had to fight. The issue with the first insurance company was whether the Peptament was a "treatment" or whether it was "supplemental nutrition." We ultimately won on the issue that this was a treatment. Since then our insurer has changed 2 times, and we've had two other fights. So far we've won them all. Happy to share pointers once you get into the fight. My best advice is to see if your gi nurse can get the insurer to send this to you directly. Sometimes the nurses can get things done, and then you don't need to have the fight that you'll have trying to get repayment. All the best, Ellen
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Re: Elemental Insurance Question
You may (and I stress MAY) be able to make a case for your insurance company being legally obliged to cover supplemental enteral nutrition if you live in Massachusetts, New Hampshire, or New York. In other states, there is less health insurance law to support you, but you could always try making your case to the insurance company. If you can't get coverage, you could also try switching to Ensure, Ensure Plus, or any of the store-brand equivalents available at various pharmacies and grocery stores. As long as your son tolerates one of these products just as well as Peptamen, it will be equally effective, and probably considerably cheaper.
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Re: Elemental Insurance Question
Our insurance only paid for the elemental if it was "the sole source of nutrition and given through an IV or tube". They only paid after she had a g-tube placed and was on exclusive elemental. At the start, when she was suplementing with enteral, we had to pay for it. The cost was out of this world!! She used peptinex. I wish insurance would pay for it no matter what...good luck.(Daughter 12, CD, bowel resection, remicade, pentasa, forvia)
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Re: Re: Elemental Insurance Question
Thanks. I'm glad my son is drinking these down, and is actually putting on weight already!However, I am now on my way out to buy a lottery ticket!
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