Blue Cross Blue Shield Federal Hypoallergenic formula coverage

[Anonymous]

Does BCBS Federal covrer hypoallergenic formula? If so how would i go about trying to obtain coverage? My pediatrician told me rio ask and let him know what he should do. However none seems to know what I'm talking about.

[Anonymous]

It may not be as simple as they do or they don't. We had BCBS (not federal) and they covered it by gtube, but not by mouth.

[Anonymous]

it's more likely that you will be able to talk to your FSA company about reimbursement. We sent in a doctor's note and demonstrated the difference in cost between regular formula and hypoallergenic. The FSA let us apply for reimbursement of that difference.

[Anonymous]

Yes they do but the loophole is that the formula needs to account for 100% of the calories the baby eats. That means if you have a 6-month old who starts purees, they will not cover formula. Not sure how/if they would check, but they must assume that by 6 months, most babies are eating solids. I yelled but obviously that made no difference.

[Anonymous]

I have heard some do with a prescription and you have to order it through the pharmacy.

[Anonymous]

16:05 poster here. If you want to try, you can call the Rx phone number on the back of your BC/BS card. I can't remember how the runaround went, but I think the person at that number gave me another phone number to call and that's where you would order the formula. Have your pediatrician write a prescription for the formula. If your baby gets 100% of its nutrition from the formula, then you order it from that number.

[Anonymous]

You can order it through a DME/Mail Order pharmacy and they will work with you to get the prescription from your pediatrician so that if your insurance covers it they'll pay.
I used Byram Healthcare. It's easiest to call.

[Anonymous]

She gets 100% of her nutrition from formula since I'm not able to breastfeed

[Anonymous]

Then you should definitely be able to get insurance to pay for it.

[Anonymous]

Sorry OP! Good luck to you. I have a federal plan (not BCBS) but they didn't cover it for us. They just read a part of our policy to me: "insurance does not cover food, nutritional supplements, or over the counter vitamins."

[Anonymous]

Anonymous wrote:Then you should definitely be able to get insurance to pay for it.

15:52 here - i was not so lucky. We were told it only would be paid for if it was through a feeding tube. That was how they defined "sole nutrition." This was for a very sick baby with FPIES and multiple food allergies. So FSA it was. Good luck OP. I hope you report back better news.

[Anonymous]

Does anyone know of another DME that I can order prescription formula from? I have BCBS federal and used byram for my last child but apparently they are not contracted with them anymore. DME list is super long

[Anonymous]

Anonymous wrote:

Anonymous wrote:Then you should definitely be able to get insurance to pay for it.

15:52 here - i was not so lucky. We were told it only would be paid for if it was through a feeding tube. That was how they defined "sole nutrition." This was for a very sick baby with FPIES and multiple food allergies. So FSA it was. Good luck OP. I hope you report back better news.

same with us, also with a baby with FPIES and multiple ieg allergies. it was bad. We had to up our FSA and that company allowed partial reimbursements but only on a per-ounce cost difference between regular formula and our Alimentum. Dr had to write supporting notes as well as the hospital after DC admitted with near-shock (part of the joys of FPIES).

[Anonymous]

Get ready to fight. Insurance will deny,deny,deny unless you push and have paperwork to back it up. It is almost criminal how they work.

Get a doctor write up and follow-up.

[Anonymous]

Try Edgepark. We have BCBS federal and were able to get hypoallergenic formula for baby's entire first year and only had to pay a copay. They shipped directly to us on a schedule every month. Baby was not tube fed either.