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.

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 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).

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 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.

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."

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

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

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.

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.

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

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.

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.

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.

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.