Baby formula prescription (plan, doctor, blood, coverage)

[CaptainNJ]

we put our daughter on nutrimigen due to some sleepless nights from bad gas. some of my wife's friends mentioned insurance covering formula. the nurse at the doctors office said it requires documented attempts of using several formulas and proof of issues like bloody stool. the doctor also rejected the idea. so i was wondering if this isnt as easy as some thought.

i just read stuff on the united oxford web site and it seems like the below are the documentation requirements. seeing as im in nj, a specialist wouldnt be needed. so im not really sure this doctor cant just prescribe it.

3. Documentation requirements:
• For Multiple Food Allergy:

a. Consultation with relevant specialist (Neonatologist, Gastroenterologist or Allergist);
and
Note: For New Jersey Commercial plans - consultation by a specialist is not
required, requests from the covered infant's physician is sufficient.

b. Diagnosis of multiple food protein allergy; and
Note: New Jersey Commercial plans also accept multiple food protein
intolerance.

c. Office notes indicating:
 failure to tolerate due to severe allergic reaction, or contraindication to available
standard cow milk based formula; and
 failure to tolerate due to severe allergic reaction or contraindication to available
standard non-cow milk based formula, (including soy-bean)

[vision33r]

I don't think it will be easy to get because the insurance company will demand the Dr to have documentation of the diagnosis and lab results of any stool samples that shows a severe allergy or gastro problem.

But there is such coverage as a co-worker has a child that was so allergenic that they have to buy the very expensive Silmilac Altimentum cans. They're like $8 per can which is good for like 2 feeds.

[CaptainNJ]

Originally Posted by vision33r

I don't think it will be easy to get because the insurance company will demand the Dr to have documentation of the diagnosis and lab results of any stool samples that shows a severe allergy or gastro problem.

But there is such coverage as a co-worker has a child that was so allergenic that they have to buy the very expensive Silmilac Altimentum cans. They're like $8 per can which is good for like 2 feeds.

in all my googling, I see people getting denied by the insurance companies while I see many people successfully getting covered for the formula (including the one we are using). I don't think ive seen anyone say that their doctor is the one being the roadblock.

from my reading, it looks like if the doctor is willing to say that there is a problem, their word is enough.