Food Allergy Living Blog Tagged Results

We know what a difference getting insurance coverage makes for Neocate families. That’s why we are happy to share a new service called the Nutricia Product Coverage Navigator, currently available in New York and Texas.

About the Nutricia Product Coverage Navigator

Nutricia Product Coverage Navigator is a resource that will provide you with assistance in obtaining insurance coverage for Nutricia products, including Neocate.

All you have to do is call 1-800-365-7354 for help with:

• Obtaining prior authorization for any and all Nutricia products, including Neocate Infant, Neocate Junior and EO28 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.

If you don’t live in New York or Texas, be sure to visit the Neocate website where you will find tips for getting Neocate coverage and details about reimbursement legislation in 14 states.

- 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 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

Our post today is a special 2 part guest blog entry from Brenda Eich. Brenda was instrumental in getting several insurance companies in South Dakota to sign an agreement guaranteeing coverage of amino acid-based formulas. We would like to thank her for sharing her story with us. This is the second part of her story.

Check out the first part of Brenda Eich's amazing journey to get medical insurance coverage for amino acid-based formulas in South Dakota.

Working with South Dakota's State Legislature

I asked an old freiend who is an attorney who I should reach out to. He gave me the name of our South Dakota State Representative - and actually the gentleman who represents my district! I met with our (wonderful) South Dakota State Representative, Todd Schlekeway. I asked him to come to our house and I showed him printed out information from Children's Magic. He was intrigued by a few things. One: that Medicaid and WIC covered Neocate; two: that it was medically-necessary; and three: it is needed by only a fraction of children so the cost to the insurance company would be minimal.

Representative Schlekeway left our house with a packet of information to read. I started a grassroots effort. I appeared on our local KELOLAND television station over the dinner hour. It didn't take much to get a following. People are very interested in children's issues. I told our personal story of allergies and medically-necessary Neocate -- and no insurance coverage but (hopeful) coverage with my new friend, Representative Schlekeway. The story was also online and gave a link to my email. I started to receive many emails! I started a spread sheet to keep the names, child's name and age, insurance company, email and address in one place. My database grew to around 30-35 families.

Initial Roadblocks Didn't Stop Us!

We began to meet as a Food Allergy Group at the local hospital and our meetings quickly turned into a "How can we get a law passed?" group. The hospital actually denied our meeting at their facility - but it didn't stop us or some of the doctors who supported our efforts. We met at a community center!

Representative Schlekeway and I tweaked our bill several times (with the help of several GI doctors and an insurance company) until we had just the right wording. It was give and take but I wasn't going to rest until it covered what these children needed. It was several weeks until he needed to introduce the bill into legislation, but it became huge leverage for us. Representative Schlekeway continued to say that we needed to educate our representatives and senators so we would get better results. He spent hours meeting with insurance companies and educated them on food allergies and this medically necessary product - Neocate.

In the meantime, I kept in close contact with Representative Schlekeway.  He asked several times for our group to send out emails to the representatives or senators or both groups. We wrote heartfelt stories with pictures of our little ones attached to the email. We told of how our children desperately needed this medically necessary product and how it wasn't covered by insurance. One gal who worked for the state talked about quitting her job so that she could get it covered by WIC, but in the long run decided to keep the job she loved and pays for Neocate out of pocket.

Finally! Some Progress with Insurance Coverage for Neocate

One day Representative Schlekeway called and had just left a meeting with my insurance company, and they unanimously agreed to cover Neocate for their insurers! This was the insurance my family had!!  Neocate would be covered forour little guy!! It brings tears and a big lump in my throat as I type.  It was such an overwhelming phone call.  Years of Neocate and finally, it was going to be covered by our insurance company! They really believed it was medically necessary and needed to be covered. God is good. 

That insurance company was then instrumental in getting other insurance companies to cover Neocate also. You see, the word got out and I was then on three different television stations and in our local newspaper.  While I didn't list the insurance companies who didn't cover Neocate, it was still bad publicity for them.The insurance companies ultimately said they wished to have a statewide agreement instead of a mandate (law).  So, the days ticked by and our group sent heartfelt emails again to our legislature. The word began to spread like wildfire! People without children even knew what Neocate was! It was such an exciting time.

Day after day, Representative Schlekeway would call with updates about insurance companies.Those that agreed would send him an agreement that the state of South Dakota would then keep on file.

The Medical Insurance Companies Jumped on Board with Our Efforts

We now have the top six South Dakota insurance companies covering Neocate. Two of them covered it immediately. One of them won't begin until January of 2011.Three of them will begin coverage on July1, 2010. We were a bit disappointed about the delay of coverage, but there has to be a start date.  Representative Schlekeway is now contacting the last two insurance companies in SD who don't cover Neocate.  We are hopeful they will begin coverage also.  The deadline for filing a bill has come and gone so that leverage is gone, but we have the other insurance companies doing the right thing.

In the beginning I set out to get coverage for my family.  When our insurance company agreed to cover our Neocate, I could have stopped and let our group plead to their own cases to their insurance companies with Representative Schelekeway.  But, I was too involved with these other families and little children.

I was asked if I would do it again. It was a lot of work, but the work I did was for our little South Dakota children who can't stand up for themselves. I have to give most of the credit to Representative Schlekeway.  Without his contacts and passion for our issue, we wouldn't have gotten to first base. (For years I wrote letters and was denied.)

My Inspiration is Helping Out Little People

It is such a wonderful feeling knowing that our little people will have the insurance coverage they need! May those of you who live in a state where Neocate is not covered, be bold and stand upto your insurance companies. Find a state senator or representative who will help you contact insurance companies and learn the lingo. Start by gathering names of food allergy families. Contact a senator or representative who will guide you and plead your case. You can do it!

I hope the following Bible passages will inspire you like they inspired me. Our pursuit in South Dakota wasn't difficult. It was a bit time-consuming on certain days. It was frustrating some days. It became my passion. In the long run, it was the most rewarding thing I have ever done.

"And if anyone gives even a cup of cold water to one of these little ones because he is my disciple, I tell you the truth, he will certainly not lose his reward." Matthew 10:42

"The King will reply, 'I tell you the truth, whatever you did for one of the least of these brothers of mine, you did for me.'Matthew 25:40

- Brenda Eich

Our post today is a special 2 part guest blog entry from Brenda Eich. Brenda was instrumental in getting several insurance companies in South Dakota to sign an agreement guaranteeing coverage of amino acid-based formulas. We would like to thank her for sharing her story with us. This is part 1 of her 2 part story.

The Initial Food Allergy Diagnosis

You have just left the doctor's office with your infant in your arms. Now you have those doctor's words circling in your mind. "Your child has multiple food allergies and will need a special amino acid-based formula like Neocate. You can't feed your child anything that has milk, soy, oats, citrus, wheat or nuts in it. Start reading labels with a microscope. "If you are lucky, you are only avoiding two or three foods. For most children with protein intolerances, IGG or IGE allergies, you are avoiding many foods.

The first few years of our little guy's life were really a blur. I spent countless hours in the kitchen trying to make meals out of a short safe-foods list.He was very small (and still is) so my main “job” was to feed him. That sounds a lot easier than it is. Most allergic children have food aversions. We continued to visit the allergist, pediatrician, GI specialist and nutritionist. All of the sudden, this little bundle of joy became a huge job like I have never known (and he is our third child). I am blessed to be a stay-at-home-mom but could it really be THIS hard??

It’s More Than Just Dealing with Food Issues

In addition to the food issues,we also had social issues. Can we really go to church, Bible study, MOPS, storytime and the park where other children are running around with frosting or cheesy crackers on their fingers? Scary! I found myself quarantining ourselves off during this journey. My main goal was to keep him safe while increasing his weight ever ever so slightly each month.

The expenses of Neocate, pediatric doctor's appointments, GI specialist appointments, allergists andmedicine (reflux) were more than we could bear. After several years of purchasing Neocate out of pocket, I started submitting letters to our insurance company. All of them came back with a standard “Request Denied”.

How My Grassroots Effort for Insurance Coverage Started

Then I met a wonderful family who has three boys. Their oldest is five and has eosinophilic esophagitis (EE). He desperately needs Neocate but with no insurance coverage, the cost is too high. His mother actually works for the hospital and the hospital insurance plan wouldn't cover Neocate. This little guy is the tiniest little five year old you have ever seen. It breaks my heart to know that he isn't the only little person who isn't getting the nutrition he needs. Many children who need Neocate don't get nearly enough or don't get it at all.

Then I heard of one family who tube feeds their child because if you tube feed, it is covered by insurance. Unbelievable! They said they hope when he doesn't need Neocate, he can be weaned off tube feeding and not have food aversions. This is just unacceptable. Neocate needs to be covered by insurance.

My blood began to boil...

After about three years of dealing with food allergies and purchasing Neocate, I decided to reach out to any others and see if they were receiving insurance coverage. We have a website where moms meet in our local area. I got back two responses from other moms who were purchasing Neocate for their little food allergy people also.

I chatted with those moms and the more I chatted, the more determined I got!

Stop back for the second half of Brenda Eich’s story about how she started a grassroots campaign to win medical insurance coverage in South Dakota for amino acid-based formulas.

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 mentioned earlier this year that a group of families in South Dakota was working to get reimbursement coverage for elemental formulas like Neocate which helps kids of all ages from infants to toddlers. A step has been made in the right direction — several insurance companies in the state have signed a voluntary agreement to reimburse for amino acid-based formula.

The insurers’ agreement to reimburse families for amino acid-based formula includes the following insurance companies:

• Avera Health Plans (effective 7/1/2010)
• HealthPartners (effective 4/1/2010)
• Medica (effective 4/1/2010)
• South Dakota State Employee Health Plan (effective 7/1/2010)
• Wellmark BlueCross BlueShield (effective 7/1/2010)

The specific conditions for which amino acid-based formulas are covered varies by plan. Be sure to check with your insurance company for details about their specific policy and when it goes into effect. Co-pays and other terms will also vary by plan.

If you want to introduce reimbursement legislation in your state, be sure to visit the Children’s MAGIC Web site and download the “Guidebook to Enacting Legislation,” which has everything you need to get started.

Don’t forget to keep us up-to-date on your efforts by posting a comment below, emailing us at foodallergyliving@shsna.com or connecting with us on Facebook or Twitter.

- Sarah

Great news for Texans – A new law, effective January 1^st, requires insurance companies to reimburse families for amino acid-based formulas like Neocate. You can read the bill here.

The new insurance reimbursement law in Texas applies to health plans that are delivered or renewed after January 1, 2010 and covers formula used to manage:

• IgE and non IgE-mediated allergies to multiple food proteins (i.e. milk protein allergy);
• Severe food protein-induced entercolitis;
• Eosinophilic disorders; and
• Impaired absorption of nutrients caused by disorders affecting the absorptive surface, functional length, and motility of the gastrointestinal tract.

The insurance reimbursement is required whether the formula is taken orally or via a feeding tube. Plus, it covers the entire Neocate product range, including Neocate Infant, Neocate Junior, Neocate One+ and E028 Splash.

Other states with reimbursement legislation for amino acid-based formulas include Arizona, Connecticut, Illinois, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Oregon and Rhode Island. However, each state’s laws are slightly different – Check out a copy of a specific state's legislation.

This is exciting news for families in Texas and we hope it will provide them with some economic relief. If you have any questions about how the new Texas legislation will affect your family, please don’t hesitate to call us at 1-800-NEOCATE.

Also, check out this news story about the new law from CBS 11 in Dallas, Texas: http://cli.gs/aG8z6E. It profiles the Stewart family whose son, Marcus, was born with Smith-Lemli-Opitz syndrome and relies on Neocate formula for his nutrition needs. The new Texas legislation will have a huge impact on their lives.

And don’t forget to share the news with others too! You can tweet the news, post a link on Facebook or share it with your support groups.

- Nita

Great news for Texans! This weekend Governor Rick Perry signed into law a bill that will require private insurance companies to cover amino acid-based elemental formulas like Neocate, regardless of whether the formula is taken orally or via a feeding tube.

Insurance reimbursement is required for the following conditions:

• IgE and non IgE-mediated allergies to multiple food proteins (i.e. milk protein allergy);
• Severe food protein-induced entercolitis;
• Eosinophilic disorders; and
• Impaired absorption of nutrients caused by disorders affecting the absorptive surface, functional length, and motility of the gastrointestinal tract.

The law applies to health plans that are delivered or renewed after January 1, 2010. To read the entire bill click here.

Other states with reimbursement legislation include Arizona, Connecticut, Illinois, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey and New York. However, each states laws are slightly different – To view a copy of a specific state's legislation click here.

This is great news for families in Texas and I expect it will provide some much-needed economic relief. I encourage you to share the news with others. Some ideas for spreading the word:

Tweet the news: New

Texas law requires insurance reimbursement for Neocate! http://bit.ly/dy2ei Blog about the news and include the link to the legislation

Post a note on Facebook:

New Texas law requires insurance reimbursement for Neocate! http://bit.ly/dy2ei

Other ideas? Please let us know.

- Nita

Right now, it seems like everyone is looking for ways to curb spending —whether that be clipping a few extra coupons or buying generic items. However, if your little one has food allergies, cost-cutting might seem a little bit harder.

Gina Clowes of Allergy Moms posted a great money saving offer on her Web site. The Center for Anaphylactic support is offering a $5.00 discount on your next EpiPen when you sign up for its automatic renewal program. This center has great resources for people with food allergies and I encourage food allergy parents to check it out here.

To read Gina’s entire entry, click here.

And if your child has a milk protein allergy, and needs an amino-acid based formula, like Neocate, you might want to look into insurance coverage possibilities for formula in your area. Click here for our blog entry on the topic.

What money saving techniques have you been using? We’d love to hear them and post them on our blog.

- Christine

A few days ago, I came across a great article in the Wall Street Journal Health blog. The blog, entitled, "Pushing Back When Insurers Deny Coverage for Treatment," is all about the ways you can appeal insurance coverage denials.

Wonderful news for allergy parents in the state of Maine. I just found out that, according to a bill signed by Governor Baldacci on April 11, 2008, insurance coverage is now required for amino acid-based formula like Neocate in Maine!

“An Act To Protect the Health of Infants” requires health insurance carriers doing business in the state of Maine to provide coverage for all medically necessary infant formula in both individual and group policies, contracts and certificates.

The bill applies to all health insurance policies, contracts and certificates enacted on or after January 1, 2008 in Maine.

Under the bill, insurance coverage for amino-acid based elemental infant formula is required for children 2 years of age and under. This is definitely a step in the right direction, but of course we would like all children who need an AAB formula to be covered.

For more information on legislation, click here.

And for ways to get involved with your states legislation, click here.

Currently, there are 9 other states with similar legislation, including Arizona, Connecticut, Illinois, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey and New York. As I’ve said before, hopefully many other states will follow with similar legislation.

- Sarah

I know many of you allergy parents out there have had issues with the insurance coverage for your child's specialized formula.

Good Morning America would like to hear your story. The show is currently asking parents to submit stories about the struggles they have faced when dealing with insurance companies. If you are interested in sharing your personal story, click here for more information.

For those of you who have been following the legislation in Maryland, click on the links below to see two great news pieces on this topic:

Gazette.net

http://www.gazette.net/stories/062608/mounnew144809_32358.shtml

WBAL

http://www.wbaltv.com/health/16719296/detail.html

Also, here is an interesting article about a little boy with EE in Chicago – the great news is that there is now insurance coverage in Illinois for children with this disease!

Great news for food allergy families! I just found out that the Maryland House Bill 578, requiring health insurance coverage for amino acid-based elemental formula, was signed at 10:00am yesterday by Governor Martin O’Malley (D). Essentially, this bill requires insurance companies in Maryland to reimburse families for amino acid-based elemental formulas, like Neocate, that are medically necessary for the “diagnosis and treatment of certain allergies, syndromes, and conditions.”

The coverage of amino acid-based formulas will be available to all policies, contracts and health benefit plans issued, delivered or renewed in Maryland on or after October 1, 2008.

Similar legislation has already been passed in the following states: Arizona, Connecticut, Illinois, Massachusetts, Minnesota, New Hampshire, New Jersey and New York. Click here to view a copy of each state's legislation.

If you don’t live in one of the above states and are interested in finding out how you can help get legislation passed it your state, visit Children’s Magic.

I expect this will provide a lot of much-needed relief for many Maryland food allergy families. Hopefully, more states will follow with similar legislation.

Take care,
Marybeth

We are happy to announce that we have added four additional states to our Nutricia Product Coverage Navigator program!  The program assists patients in obtaining insurance coverage for Nutricia products, including Neocate.  When we first launched in November 2010, the program was only available in New York, Texas and Massachusetts, but now it is offered in Arizona, Connecticut, Illinois and New Jersey!

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 EO28 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.

If you don’t live in Arizona, Connecticut, Illinois, Massachusetts, New Jersey, New York or Texas, please visit the Neocate website where you will find tips for obtaining coverage and details about reimbursement legislation.

- Sarah