Sample Letter for
Neocate ® One+
DATE: ______________________________
TO: ______________________________
(Insurance Company)
FROM: ______________________________
SUBJECT: ______________________________
I am requesting insurance coverage and reimbursement for my patient, ___________________________________, for whom I have prescribed the use of Neocate® One+ (manufactured by Nutricia North America).
I feel that Neocate One+ is a medical necessity and will provide the proper dietary management for this patient, who has been diagnosed with __________________________________. Without the use of Neocate One+, my patient may experience complications of the condition, which may result in hospitalization and/or costly parenteral nutrition.
Neocate One+ is an amino acid based nutritionally complete elemental formula. It is specifically designed to meet the nutritional needs of one to ten year olds who are unable to ingest a normal diet or other hypoallergenic products. Its unique formulation (100% free amino acids, milk-free, gluten-free, and soy protein-free) provides complete nutrition and can often be the sole source of nutrition. Neocate One+ has an elemental composition which requires minimal digestion, thus ideally suited for patients with compromised gastrointestinal function.
The FDA classifies Neocate One+ as a “medical food” which must be used under medical supervision and is not sold over the counter or at the retail level. Therefore, Neocate One+ is only available through a pharmacy or through Nutricia North America directly (with medical consent). For additional reimbursement codes and information, please see the reverse side.
Your approval of this request for insurance coverage and reimbursement of the Neocate One+ would make a significant impact on this patient’s health.
Sincerely,
NEOCATE AND REIMBURSEMENT
Third-party payers such as Medicaid and HMOs will reimburse for the cost of Neocate One+. To process claims for Neocate One+, payers require a reimbursement code to identify the nutritional product/category. Some states have enacted legislation, which require that reimbursement be provided based on the patient’s diagnosis.
Claims are usually processed in one of two ways. A code is used to identify Neocate One+ through the HCFA Healthcare Procedure Coding System (HCPCS), or through the National Drug Code (NDC) system. Most states will use one of these systems to classify Neocate One+ for reimbursement purposes. Individual insurance plans will also choose one of these systems to reimburse patients for nutritional products.
CODING SYSTEMS:
MEDICARE (HCPCS)
Neocate One+ is classified under Code # B4161.
NATIONAL DRUG CODE (NDC)
Neocate One+ is not a drug but is classified by the FDA as a “medical food”, which requires usage under strict medical supervision. The NDC code for the Neocate One+ is 49735-0110-48.