nj state law and "special" infant formula.... (dermatologists, college)

[bradykp]

Originally Posted by CaptainNJ

how much does the formula cost?

it's $204 for a case of 6 14.1oz powder cans. each can at his current consumption will last about 3 days. it's obscene. it's worse than the other allergy formulas that are made of milk protein, but the protein is broken down. this formula has nothing he could be allergic to. it's mostly corn i think. gonna break the bank!

[bradykp]

so a nurse from our insurance followed up on the hospital visit and the subject of the formula came up. she explained the regular customer service peeps don't know about the state laws (suprise), and that we have to file a form for appeal, and it should be approved, based on NJ's law. if that happens, we'll be in much better shape. pediatrician said most children grow out of it. also, he's only on this formula because of his severe reaction that landed him in the hospital. they don't truly know if he has a food allergy, but it's the most logical explanation. the hospital had this formula for him, and he did fine with it, so doctors don't want to risk trying the other hypoallergenic formulas if this one is working. doh.

[CaptainNJ]

Originally Posted by bradykp

it's $204 for a case of 6 14.1oz powder cans. each can at his current consumption will last about 3 days. it's obscene. it's worse than the other allergy formulas that are made of milk protein, but the protein is broken down. this formula has nothing he could be allergic to. it's mostly corn i think. gonna break the bank!

so thats like $400 a month on formula?? holy crap!!

[joe moving]

does your wife work/consider breast feeding? might be a lot harder now if she hasn't been doing itall along.

[CaptainNJ]

Originally Posted by joe moving

does your wife work?

im trying to figure out the relevance of this question (or it could be just curiosity).

[nasayin]

@bradykp,

Is your son on Neocate or Elecare? Most medical insurance should cover this. I have Aetna for medical and Medco for prescription. My son is on Neocate right now and I wasn't able to get Medco to cover since it is over the counter. So I called Aetna and they said my plan covered it but to get them to pay for it was a pain. It took almost 3 weeks before they authorize it and those powder formula cost $50/can. My son was going thru them in 2 days. Here is what you need to do, go get the insurane letter template from Neocate website and have your ped fill it out. Fax the letter to your medical insurance and call them everyday.

[url=http://www.neocate.com/reimbursement/resources/#sample-letters]Resources You Can Use | Reimbursement Definitions and Codes, Sample Insurance Letters[/url]

On another note: we went to see ped twice, 2 dermatolgists about 5 visits total, and an allergist twice for my son's condition. Even after putting him on Neocate he wasn't getting better. We finally went to CHOP and they were able to diagnose him with Staph infection. If you want to get another opinion, I would highly recommend bringing your son to CHOP.

Good luck!

[NJGOAT]

Originally Posted by bradykp

so a nurse from our insurance followed up on the hospital visit and the subject of the formula came up. she explained the regular customer service peeps don't know about the state laws (suprise), and that we have to file a form for appeal, and it should be approved, based on NJ's law. if that happens, we'll be in much better shape. pediatrician said most children grow out of it. also, he's only on this formula because of his severe reaction that landed him in the hospital. they don't truly know if he has a food allergy, but it's the most logical explanation. the hospital had this formula for him, and he did fine with it, so doctors don't want to risk trying the other hypoallergenic formulas if this one is working. doh.

brady, I posted in your thread on the Parenting forum about this and what we went through with our kids. Only my oldest got to the point where he couldn't tolerate milk or soy based formula's, though he never got as bad as your son did. The other's all did fine with soy...and they thankfully outgrew it by 12-16 months.

When the doctor said we would need a hypoallergenic formula we looked into getting it covered through insurance and though we got further than you did at first we basically hit a brick wall with it over Nutramigen. Since it was commonly available OTC they wouldn't reimburse us. The next level of formula's beyond that would have been, but would require a diagnosis that Nutramigen wasn't working and that only a specific formula would work.

It sounds like your sons doctors are going to standby the formula he is on and medically require it, so you should be good to go with an appeal. My son wasn't as bad and we needed to try the commonly available ones before moving on. Thankfully (unfortunately, lol), Nutramigen worked and we were stuck with the bill.

[NJGOAT]

Originally Posted by joe moving

does your wife work/consider breast feeding? might be a lot harder now if she hasn't been doing itall along.

Originally Posted by CaptainNJ

im trying to figure out the relevance of this question (or it could be just curiosity).

My guess he is assuming that if she is working she has decided not to breastfeed, hence why they are using formula and the baby has the issue.

Being somewhat familiar with this problem though, breastfeeding does NOT solve the issue if there is a protein allergy that is causing the problems. In order to continue breastfeeding the mom would need to eliminate anything from her diet that contains the allergens. Depending on the extent of the allergy, this can be almost impossible or at the very least very difficult as most foods contain dairy, soy or wheat. If the allergies are bad it is far better to switch to a hypoallergenic formula than trying to strip any variables out of mom's diet.

[bradykp]

Originally Posted by CaptainNJ

so thats like $400 a month on formula?? holy crap!!

he's eating 5oz per feeding right now. at that rate, he goes through a can every 3 days. so 6 cans would last 18 days. but....he's going to increase to more oz, and less feedings per day. so we'll see. but yeah, around $400/month on formula.

[bradykp]

Originally Posted by nasayin

@bradykp,

Is your son on Neocate or Elecare? Most medical insurance should cover this. I have Aetna for medical and Medco for prescription. My son is on Neocate right now and I wasn't able to get Medco to cover since it is over the counter. So I called Aetna and they said my plan covered it but to get them to pay for it was a pain. It took almost 3 weeks before they authorize it and those powder formula cost $50/can. My son was going thru them in 2 days. Here is what you need to do, go get the insurane letter template from Neocate website and have your ped fill it out. Fax the letter to your medical insurance and call them everyday.

Resources You Can Use | Reimbursement Definitions and Codes, Sample Insurance Letters

On another note: we went to see ped twice, 2 dermatolgists about 5 visits total, and an allergist twice for my son's condition. Even after putting him on Neocate he wasn't getting better. We finally went to CHOP and they were able to diagnose him with Staph infection. If you want to get another opinion, I would highly recommend bringing your son to CHOP.

Good luck!

wow...this sounds EXACTLY like my scenario. I have Anthem + Medco. Medco said they won't cover it because it's considered over the counter. Anthem actually called us to ask about the hospital visit, and it was a nurse at Anthem. She understood the existence of the NJ law, and said the reps do not know that level of detail. She told us we can fill out a form to appeal, and it will likely be covered. We can't use Neocate, to my knowledge, or it might just be that the EleCare is what worked at the hospital, so they don't want us to change.

our son is fine on the EleCare. it is likely a food allergy, and there's a cross-relation of milk and soy allergies. my wife had cut out dairy from her diet while breast-feeding, but hadn't entirely cut out soy (it's very difficult to cut out both). CHOP would be our next step if he has another episode.

how old was your son when his condition started?