Guest guest Posted December 10, 2004 Report Share Posted December 10, 2004 I'm not done with the insurance, but I really think I'm fighting a losing battle. My husband works for the city and they are self-insured. His employer just changed group plans on Oct 1st. The prior insurance company was paying for it, but the new plan says it's not covered. We had our doctor write a letter of medical necessity and appealed it, but they say since it's his whole source of nutrition, it's not covered because " everyone has to eat " . I think the employer really screwed up when they went with this new plan. Our son had very high medical bills this year, along with another co-worker whose newborn spent 5 months in NICU. Instead of raising all the employee's health care premiums, it seems to me, they went with a " lesser " plan to keep the costs down. I've put a call into the city's HR director today. Before my son was born I worked for a large corporation in HR for 5 years, so I know a few things about benefits, etc. I hoping they'll just get sick of me being a constant pest and figure out a way to pay for it. It's funny how they will pay for all the feeding bags and extension tubes, feeding pump, etc - just not the stuff that goes in them. My son does get ECI services. We have PT, OT & speech. He also gets vision services from our school district. He's been enrolled since he was 4 months old. We tried to get WIC but make too much money. Thanks for hearing me out..... I'm really frustrated today. My day started off by getting my son out of his crib, which was soaked with 5 oz. of RCF formula (yuck!)and all his meds! I guess I didn't get him hooked up just right when I started his feed. Now I know what everyone means when they " feed the bed " . ha ha! RE: Keto diet via G-tube.... Help TO SHELLEY! , I am so surprized that your insurance will not pay for it since your son has a feeding tube. Our insurance would only pay for it if our daughter had her feedign tube. I just had about 10 cases and threw it out last week. I wish I would have known I would have shipped it to you. You can also check with WIC, Womens Infant and Children, services. They will provide you with RCF with a doctors prescription. If you qualify for Medicade youll qualify for WIC. They only offer service through age 5 but it helps. Also are you involved eith ECI, Early Childhood Intervension. They are also wonderful and help through age 3. My daughter is 26 months old. We were on the keto diest from March 2003 thru Jan 2004, but we were loosing too much weight so we got off. Just some suggestions, hope they help you some. Kristi (mom to Wyaema 26 months, keto kid March 2003-Jan 2004) ===== Kristi Mann Smile make everyone wonder what your thinking May God Bless you today, tomorrow and always " The Ketogenic Diet....a realistic treatment option, NOT just a last resort! " List is for parent to parent support only. It is important to get medical advice from a professional keto team! Subscribe: ketogenic-subscribe Unsubscribe: ketogenic-unsubscribe Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 10, 2004 Report Share Posted December 10, 2004 , Could you call the state insurance commisioner to see if there is anything they could do to help? Hallie Subject: RE: Keto diet via G-tube.... Thanks Kristi and Jim I'm not done with the insurance, but I really think I'm fighting a losing battle. My husband works for the city and they are self-insured. His employer just changed group plans on Oct 1st. The prior insurance company was paying for it, but the new plan says it's not covered. We had our doctor write a letter of medical necessity and appealed it, but they say since it's his whole source of nutrition, it's not covered because " everyone has to eat " . I think the employer really screwed up when they went with this new plan. Our son had very high medical bills this year, along with another co-worker whose newborn spent 5 months in NICU. Instead of raising all the employee's health care premiums, it seems to me, they went with a " lesser " plan to keep the costs down. I've put a call into the city's HR director today. Before my son was born I worked for a large corporation in HR for 5 years, so I know a few things about benefits, etc. I hoping they'll just get sick of me being a constant pest and figure out a way to pay for it. It's funny how they will pay for all the feeding bags and extension tubes, feeding pump, etc - just not the stuff that goes in them. My son does get ECI services. We have PT, OT & speech. He also gets vision services from our school district. He's been enrolled since he was 4 months old. We tried to get WIC but make too much money. Thanks for hearing me out..... I'm really frustrated today. My day started off by getting my son out of his crib, which was soaked with 5 oz. of RCF formula (yuck!)and all his meds! I guess I didn't get him hooked up just right when I started his feed. Now I know what everyone means when they " feed the bed " . ha ha! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 13, 2004 Report Share Posted December 13, 2004 , Is he or couold the doctor claim failure to thrive and have the insurance pay for it. I know that once my daughters g-tube was removed our insurance would no longer pay for it and we claimed failure to thrive and they payed it. Wyaema was having probelms gaining weight on the diet, that is why we got off. I wish there was more I could do. We barely qualify for WIC, my husband is active duty military and our housing allowances almost throws us over. I know how fustrating it is. Good luck! If I found out of anymore sources Ill email you! Kristi Mann ===== Kristi Mann Smile make everyone wonder what your thinking May God Bless you today, tomorrow and always Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 13, 2004 Report Share Posted December 13, 2004 ahhh - that may be a good idea. Reid is in the 3% of height to weight and we have been trying to get him gain. I'll mention that when I call my dr. today. Thanks! Re: Keto diet via G-tube.... Thanks Kristi and Jim , Is he or couold the doctor claim failure to thrive and have the insurance pay for it. I know that once my daughters g-tube was removed our insurance would no longer pay for it and we claimed failure to thrive and they payed it. Wyaema was having probelms gaining weight on the diet, that is why we got off. I wish there was more I could do. We barely qualify for WIC, my husband is active duty military and our housing allowances almost throws us over. I know how fustrating it is. Good luck! If I found out of anymore sources Ill email you! Kristi Mann ===== Kristi Mann Smile make everyone wonder what your thinking May God Bless you today, tomorrow and always " The Ketogenic Diet....a realistic treatment option, NOT just a last resort! " List is for parent to parent support only. It is important to get medical advice from a professional keto team! Subscribe: ketogenic-subscribe Unsubscribe: ketogenic-unsubscribe Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 16, 2004 Report Share Posted December 16, 2004 Hi our daughter has had a mic-key button for 7 years. It is great. Caiite started the diet in March. Caitie is on RCF, Microlipid, Polycose and Water. and vitamins, minerals and electrolytes. We have insurance, Medicaid waiver and children special health care. Everything is paid for by the insurance because failure to trive and aspirating problems. We live in Indiana and Caitie is on the aged and disabled waiver. Through this waiver we get Medicaid and nursing hours for Caitie. Hope you can find away to get this covered. If you need any help I will try. Sherri (mom to Caitie) March 04 4:1 Quote Link to comment Share on other sites More sharing options...
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