Food Allergy Living Blog Tagged Results

We get a lot of questions from food allergy families about how to get insurance to cover elemental formula like Neocate. While some insurance companies do reimburse families for these formulas, many do not.

At Nutricia, we feel strongly that formula reimbursement is something insurance should do. And since too many insurers are not providing this important coverage, state laws should make sure that they do. After all, any parent who has had to watch their child endure the misery of food allergies, dairy and soy protein intolerance (MSPI), eosinophilic esophagitis (EE) or gastroesophageal reflux (GER), realizes how medically necessary elemental formulas are for certain kids.

The good news is that 13 states have some type of formula reimbursement legislation. The bad news is that only 13 states have some type of formula reimbursement legislation.

That’s why Children’s Magic exists. Children’s Magic is non-profit (a 501c4) organization. Their mission (straight from the website) is:

Children’s Milk Allergy and Gastrointestinal Coalition (MAGIC) is committed to promoting healthcare coverage and reimbursement of amino acid-based elemental formulas for children who are unable to consume a natural, life-sustaining diet due to various allergies or diseases.

They are working hard, state by state, to introduce new laws (or expand old ones) to ensure that insurers provide this coverage to the families who so desperately need it.

But, they can’t do it alone. They often need help from families like yours to rally grassroots support for legislation in your own communities.

You can check out their site to see if elemental formula reimbursement is required by law in your own state. If you want to know how you can help, you can reach out to them at info@childrensmagic.org.

And, if you want to find out about how you can lead the charge for elemental formula legislation in your home state, you can download the Children’s Magic Guidebook for Enacting Legislation.

- Sarah

With the help and hard work of many families, there have been several states that have mandated legislation for medical insurance coverage of amino acid-based formulas such as Neocate. This is fantastic news that will help to provide financial relief for families.

The current states that require coverage for amino acid-based formulas:

• Arizona
• Connecticut
• Illinois
• Maine
• Maryland
• Massachusetts
• Minnesota
• New Hampshire
• New Jersey
• New York
• Oregon
• Rhode Island
• South Dakota
• Texas

Every state and every law/agreement is different so be sure to read thoroughly to understand the limitations before contacting your medical insurance company. For example, the Maine legislation only pertains to children under the age of 2. In the state of Minnesota, there is no law requiring coverage, however, the state’s six largest insurance plans have agreed to reimburse families for amino acid-based formula. We have a full list of the states that reimburse and information on each law at Neocate.com.

Tips for Amino Acid-based Formula Reimbursement

A few tips to keep in mind when pursing reimbursement in each of these states are listed in the reimbursement section of Neocate.com. For instance, most of the mandates/agreements only require coverage of amino acid-based formulas for the diagnosis and treatment of certain medical conditions (i.e. eosinophilic gastroenteritis or multiple food protein intolerance).

If your state is not listed and you would be interested in joining the fight for coverage in your state, check out the guidebook for enacting legislation from Children’s Magic. Children’s Magic is an organization committed to promoting reimbursement for elemental formulas. They have put together this guide to help point you in the right direction.

Stay tuned for a guest blog post from Brenda Eich next week. We are honored to have her share her story on her successful fight for medical insurance reimbursement in South Dakota! Does anyone else have success stories or tips to share with getting insurance coverage for Neocate?

- Sarah

We get a lot of questions from food allergy families about how to get insurance to cover elemental formula like Neocate.  While some insurance companies do reimburse families for these formulas, many do not.

At Nutricia, we feel strongly that reimbursement for formulas that are medically necessary is something insurance companies should do.  Getting help with the costs of feeding a child with cow milk, soy or protein allergies, or severe GI issues, can go a long way to helping the whole family feel better.  

On the Neocate website we have lots of resources and information that can help you find reimbursement for the medical foods and exempt infant formulas your child needs to thrive. You may be eligible for private insurance coverage, government support and even assistance from us.

We are especially proud of our Nutricia Product Coverage Navigator program! The program assists patients living in Arizona, Connecticut, Illinois, Massachusetts, New Jersey, New York or Texas obtain insurance coverage for Nutricia products, including Neocate.

So, if you are a resident of Arizona, Connecticut, Illinois, Massachusetts, New Jersey, New York or Texas please call 1-800-365-7354 for help with:

• Obtaining prior authorization for any and all Nutricia products, including Neocate Infant, Neocate Junior and E028 Splash;
• Answering questions regarding claims submissions;
• Drafting letters of medical necessity;
• Providing instructions on how to correct billing errors;
• Interceding with the insurance company on complex reimbursement matters; and
• Appealing a denied claim.

But, if you don’t live in one of these states, please visit the Neocate website where you will find tips for obtaining coverage and details about reimbursement legislation.