LEB

I have a 7 month old with milk and soy allergy with a anaphylaxis reaction when given a milk product (one ounce of regular infant formula mixed with breast milk is how we found out at 3 months). She has been prescribed neocate infant formula by her allergist and doctor. My insurance company denied the claim for coverage of the neocate, then after submitting letters from both doctors they denied the claim a second time stating that while they agreed the formula was medically appropriate it was not covered by our plan. No food products will be covered unless administered through a feeding tube. Had anyone dealt with this? Any suggestions on other information I should be submitting to my insurance company to get coverage other than letters of medical necessity that I have already submitted? Any help would be appreciated.

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bdmd

I am a family doctor, and although I have not dealt with prior authorizations on neocate before, I have had to deal with that obstacle on multiple other treatments. I would recommend you urge both of your doctors to call the insurance company directly and speak with their medical director about your case. It certainly will not hurt, and you would be surprised at how much more effective a phone call is than a letter. I have on numerous occassions had the insurance company deny an appeal in writing, only to have them grant the approval after a phone call by me. A lot of times, the insurance companies are just trying to see "how bad" your doctors want the patient to have the treatment. If your doctors will not do this for you, then I suggest finding new one(s); they should be willing to "go that extra step."

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