Re: formula insurance coverage and Peptamen Junior

August 9, 2001

Inga,

We were able to get Peptamen covered by insurance because my husband was

persistent and just did not let up on them. At the time, Max received most

of his nutrition through his pump feedings. , my husband, told them

that this formula was medically necessary because the pump was medically

necessary. He then went on to say that if Max did not have this Peptamen,

then he would be in the hospital having IV fluids and that would be a whole

lot more expensive than the formula. He also pointed out that if Max was in

the hospital and they fed him by pump, then the insurance would cover that,

too. We had approval the next day.

Jodi

formula insurance coverage and Peptamen Junior

> I have asked my doctor to consider asking the insurance company to cover

> Peptamen Junior again. I gave him a copy of an email someone sent awhile

> back saying that they were able to get 5 more ounces into their son

without

> vomiting and that Dr. Harbison had recommended it - that it is absorbed

> better. A few years ago, he wrote about this, but he only said it was a

> high calorie formula - which was not my reason at all since Pediasure is

> the same. We were rejected by this previous insurance company. Does

> anyone have any sample letters or ideas for how to present this case to

> insurance companies? I think some have Pediasure covered, which we do

> ourselves now, but perhaps ideas these people have used may come in

handy...

>

> Thanks!

>

> Inga

>

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