Re: Pediasure Insurance Coverage??

[Guest guest]

Alison,

We fought this battle with our insurance company and won! They, too, said

that Max did not use his formula as a major source of nutrition. But we

told them that if he did not receive these feedings at night, then he would

get too sick and wind up in the hospital, which is much more expensive than

paying for the formula. The only advantage the we had over you is that Max

was on Peptamen - something that has to be ordered. You cannot buy Peptamen

in the grocery store as you can Pediasure these days.

Jodi

Pediasure Insurance Coverage??

> We were just informed that our request for Pediasure to

> be covered by our insurance carrier has been denied.

> Jake just had a feeding tube put in a few weeks ago.

> The insurance company's reason for denial is that since

> Jake's sole source of nutrition is not coming through

> the feeding tube, they will not cover Pediasure. (He

> currently drinks Pediasure by mouth during the day, and

> uses the feeding tube for continous night feeds). Any

> other finger foods he takes by day, would not sustain

> life.

>

> Obviously, we are going to appeal this decision, but

> were wondering if anyone else has successfully fought

> this with their insurance company and if so could you

> offer some tips.

>

> Thanks,

> Alison (mom to Jake, 18 months, 16 pounds)

>

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>

>

[Guest guest]

Hi ,

In addition to Jodi, I'm pretty sure I remember someone on our list writing

within the last year that they had received insurance approval for pediasure. I

just can't remember who!

Katy

[Guest guest]

Hi Alison,

When we had cigna insurance, they didn't cover for pediasure even

though my daughter had a G-tube but we weren't seeing Dr.H then(they

didn't cover Dr.H either ). Later when we met Dr.H. she said, no

matter what insure you have, if the child has a G-tube(not sure about

NG- tube) they have to cover it. I guess, our GI doctor didn't know

about it but if you have a good doctor to advocate for you, they will

approve it.

Good luck,

Mini

[Guest guest]

My insurance does cover Pediasure for Cody--It took several

weeks for it to go through, but I had to get a letter from his ped.

stating that it is medically necessary for him to still be on formula

and to be on Pediasure, and now I get both through the

pharmacy. His ped. just writes out a prescription with refils and

writes a new one as necessary.

Sheila