Make sure your submission is complete and according to your insurance company’s guidelines.
Consider providing the following:
Ask to speak to a Nurse Case Manager in your insurance company. He or she will better understand the nuances of your situation. Don’t stop with Customer Service.
If you are denied coverage, use all the appeals levels: 1st, 2nd, 3rd and Grievance. Document everything. Write down the full name of every person you have spoken to and what they have said on each date.
Use FSA (flexible spending account) dollars to pay for the formula (if your employer has one).
Find out the process for using a mail order prescription program (if you have one) through your employer. Try to get Neocate through your mail order benefit by following the same procedure you would for other medications.
Your physician can be your advocate. Ask them to write a letter of medical necessity including the following:
The more detailed the information you and your doctor provide, the better the chances for reimbursement.