Reimbursement Resources




Nutricia Product Coverage Navigator

We understand the challenges patients and caregivers encournter when attempting to obtain coverage for medical foods.  That's why we are happy to provide the Nutricia Product Coverage Navigator.

The Nutricia Product Coverage Navigator program includes assistance with:

  • Obtaining prior authorization for any and all Nutricia products
  • Answering questions regarding claims submissions
  • Drafting letters of medical necessity
  • Instructions on how to correct billing errors
  • Working with the insurance company on complex reimbursement matters
  • Appealing a denied claim
  • .....And much, much more

Need personalized assistance with Neocate coverage?

Call 1-800-365-7354 ext. 1200 or email NutriciaNavigator@nutricia.com

Insurance Coverage Map

Insurers in 14 states provide some form of reimbursement to families for medical foods and exempt infant formulas like Neocate. The specifics for each state are different. Don’t see your state here? Take a look at other reimbursement programs that may be able to help. Click on your state below to learn more about what coverage is provided.

Map of States Requiring Coverage

The reimbursement process can be frustrating even if insurers in your state provide coverage. You need to understand both your rights under the law and the requirements of your insurance provider. To increase your chance of success, it’s important to provide your company with the information they require to process your claim.

Nutricia North America, the makers of Neocate supports legislative efforts in other states to require that insurance companies reimburse families for medical foods and exempt infant formulas like Neocate.


Arizona

Bill name: House Bill 2364

Effective date of the law: April 2006

Your coverage:

  • Insurance reimbursement for children diagnosed with eosinophilic esophagitis (EoE)
  • Insurance will reimburse 75% of the formula cost, with an annual cap of $20,000
  • Insurance covers formula administered orally or by a feeding tube

Read the Arizona bill.


Connecticut

Bill name: Chapter 700c – Health Insurance

Effective date of the law: October 2001

Your coverage:

  • Insurance covers amino acid-based formula for children with any medically necessary diagnosis up to age 8
  • Insurance covers formula administered orally or by a feeding tube

Read the Connecticut bill.


Illinois

Bill name: Senate Bill 935

Effective date of the law: January 2008

Your coverage:

  • Insurance covers amino acid-based formula for the diagnosis and treatment of eosinophilic esophagitis (EoE) and short bowel syndrome (SBS)
  • Insurance covers formula administered orally or by a feeding tube

Read the Illinois bill.


Maine

Bill name: An Act to Protect the Health of Infants

Effective date of the law: January 2008

Your coverage:

  • Insurance reimbursement of amino acid-based formula for children age 2 and under diagnosed by a physician with allergic colitis or proctitis, eosinophilic esophagitis (EoE) with lab results, anaphylaxis, gastroesophageal reflux disease (GERD) that is nonresponsive to standard medical therapies, severe vomiting or diarrhea resulting in dehydration, cystic fibrosis, malabsorption of cow- or soy-milk-based formula
  • Insurance covers formula administered orally or by a feeding tube

Read the Maine bill.


Maryland

Bill name: House Bill 578

Effective date of the law: October 2008

Your coverage:

  • Insurance reimbursement of amino acid-based formula for food protein allergies, enterocolitis, disorders affecting gastrointestinal motility and eosinophilic esophagitis (EoE)
  • Insurance covers formula administered orally or by a feeding tube.

Read the Maryland bill.


Massachusetts

Bill name: Coverage for Nonprescription Enteral Formulas for Home Use

Effective date of the law: January 1994

Your coverage:

  • Insurance reimbursement for amino acid-based formula for the treatment of Crohn’s disease, ulcerative colitis, gastroesophageal reflux disease (GERD), gastrointestinal motility, chronic intestinal pseudo-obstruction, and inherited diseases of amino acids and organic acids

Read the Massachusetts bill.


Minnesota

No law in place but there is an insurers’ agreement

Effective date of agreement: May 2007

Your coverage:

  • The insurers’ agreement reimburses families for amino acid-based formula and is supported by the state’s six largest insurance plans:
    • BlueCross BlueShield of Minnesota/Blue Plus
    • HealthPartners
    • Medica
    • PreferredOne
    • Sanford Health Plan
    • First Plan of Minnesota
  • Conditions covered include milk protein allergies, allergic enterocolitis, eosinophilic esophagitis (EoE) and short bowel syndrome (SBS)
  • Co-pays and other terms vary by the plan

Read Minnesota Administrative Rule 9505.0325, Insurer's Letters, SF 504 and Senator Torres Ray's letter.


New Hampshire

Bill name: House Bill 1431

Effective date of the law: 1996

Your coverage:

  • Insurance covers all nonprescription amino acid-based formulas for disorders affecting gastrointestinal absorptive surface, functional length and motility

Read the New Hampshire bill.


New Jersey

Bill name: Chapter 361

Effective date of the law: March 2002

Your coverage:

  • Insurance reimbursement for amino acid-based formula for infants with multiple food protein intolerance (MPFI)
  • Insurance covers formula administered orally or by a feeding tube

Read the New Jersey bill.


New York

Bill name: Article 32 – Insurance Law

Effective date of the law: 1994

Your coverage:

  • Insurance reimbursement for amino acid-based formula for the treatment of conditions that include, but are not limited to, inherited diseases of amino and organic acid metabolism, Crohn's disease, gastroesophageal reflux disease (GERD) with failure to thrive, disorders of gastrointestinal motility such as chronic intestinal pseudo-obstruction and multiple severe food allergies

Read the New York bill.


Oregon

Bill name: House Bill 3496

Effective date of the law: January 2010

Your coverage:

  • Insurance reimbursement of amino acid-based formula for children diagnosed by a physician with severe intestinal malabsorption
  • A physician has to issue a written order for the formula, and the formula comprises the sole source, or an essential source, of nutrition
  • Insurance covers formula administered orally or by a feeding tube

Read the Oregon bill.


Rhode Island

Bill name: An Act Relating to Insurance – Enteral Nutrition Products

Effective date of the law: January 2009

Your coverage:

  • Conditions covered include Crohn’s disease, ulcerative colitis, gastroesophageal reflux disease (GERD), chronic inherited pseudo-obstruction, inherited diseases of amino and organic acids

Read the Rhode Island bill.


South Dakota

Bill name: No law in place but there is an insurers’ agreement

Effective date of the agreement: 2010

Your coverage:

  • The insurers’ agreement reimburses families for amino acid-based formula and is supported by the following insurance plans:
  • The specific conditions for which amino acid-based formulas are covered varies by your plan. Be sure to check with your insurance company for details about their specific policy
  • Co-pays and other terms also vary by plan

Learn more about South Dakota bills: 58-17-62, 58-18-41, 58-38-23, 58-40-21 and 58-41-98.


Texas

Bill name: HB 2000

Effective date of the law: January 2010

Your coverage:

  • Insurance reimbursement of amino acid-based formula for children diagnosed by a physician with milk protein allergy, eosinophilic esophagitis (EoE), short bowel syndrome (SBS) and enterocolitis
  • Insurance covers formula administered orally or by a feeding tube

Read the Texas bill.