[DYSPHAGIA] Ins co pay for formulas?

[julia@simmons-family.org (Julia Simmons)]

This question has come up on another list and I thought ya'll might have
some insight? Some private insurance companies pay for enteral feeding
supplies (bags, pumps, etc.) but not the actual formula. Others pay for
the formula, or at least a portion of it. Even if a child is receiving
99% of his calories via g-tube, this particular ins co is calling the
formula "supplemental" and refusing to pay.

Does anyone out there have any suggestions for getting an ins company to
pay when they initially refuse? Letters you've written, particular
wording you've used....

This family I'm helping has letters from ENT and a pulmo that state the
child aspirates solid food, but that didn't help.

Thanks.
Julia Simmons
mom to Woody (age 2.5, g-tube, trach, hypotonia, shunt, beautiful
smiles, etc.) and Randy, age 4, train and shark expert

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