I HATE our insurance company

MyBlueEyedBabies wrote: Ok so Johnny hit that great milestone of ten pounds because we finally got him on a formula that works...problem being it's 35 freaking dollars a can and our insurance wont cover it. They would seriously rather pay another $35,000 hospital stay than for the formula. To make it worse every perosn we talk to tells us to call someone else and when it comes down to it it still won't get covered.

ZandersMama replied: that sucks! is there anyway the doctor could get in touch with the insurance company?

MyBlueEyedBabies replied: Nope insurance company has an exclusion about any kids of specialty food infant formula included. It is only covered in the hospital and at that it's only 80%. We go to the Dr. on monday hopefully he will have some idea...but I don't think there is anythign anyone can do to get our insurance to do something. I HATE THEM

PrairieMom replied: THey are right about noone else covering it, If you switched companies, it would be considered a pre-existing condition. I feel ya. I HATE health insurance. What a racket. Even just the word Health insurance makes me . It totally sucks that you have to pay all that $. How long does a can of formula last?

boyohboyohboy replied: by chance is the formula neocate?

MoonMama replied: Insurance companies just make me madder and madder.

MyBlueEyedBabies replied: not Neocate EleCare though I think they are pretty much interchangable. They act like its nit a big deal and we can just pay for it but $35 a can times 2-3 cans a week...not terribly affordable. Plus dh works for the city and they are their own insurance company so they pay the employees nothing and then cover nothing. I have no idea how they expect to keep loyal employees. No one can afford to keep working for them

Cece00 replied: I'd REALLY keep after them.

First, I'd get a letter from your ped stating how VERY NECCESSARY it is

Then, I'd call them & I would get someone BIG on the phone. Not a customer service agent, like a supervisor. If they dont help you, ask for THEIR supervisor.

And then I would bug and bug and bug and bug them, if it meant I had to call every day. And keep reminding them that its cheaper for them to pay for the formula than the hospital visit.

I'd also bring all my insurance paperwork, explaining the benefits, to a lawyer and get his or her opinion on them not wanting to pay for the formula.

Cece00 replied: Also, do you qualify for WIC? Perhaps they can help cover the costs for you?

MyBlueEyedBabies replied: Crystal it states in our policy they will not cover it period. the only exception is in the hosiptal and leading up to or immediately after an essential surgery. JOhnnys was concidered elective. He could eat walkin gin the door and could eat walking out the door so they have no coverage for him. I went through to the Dr's at teh hospital and even they said that there is no way to get it covered outside of having him readmitted. unfortunatly that won't exactly help in the finances dapartment. We are not the first of the city employees to fight this battle and I'm guessing we wont be the last. The whole ordeal is making Michael look much harder for a new job and not really caring where it is. Maybe we will make it closer to our parents.
On teh plus side I should be getting a check in teh mail from my mom today as she offered to help pick up some of it.

lovemy2 replied: I hear ya on the expensive formula thing - Dylan is on a steak and lobster diet too - he is on the Alimentum - not $35 a can but $22...but my Ped gives me lots and lots of cans of it for free....thankfully - does your Ped get any samples???

Cece00 replied:
This is a good idea. Maybe your ped could get some of the sample cans for you, he should be able to get those. You might also call the makers of the formula & explain what is going on to them, and ask if they might be able to help a little. Kind of like how certain pharm. companies have programs to help ppl pay for prescriptions they need but can not afford.

MommyToAshley replied: That sucks! Insurance sucks! I'm sorry.

I would call the hospital finance office and ask them if they have any programs that cover this kind of thing. My friends's little girl had seizures when she was younger and the hospital found a group that would cover her medical bills as she had no insurance. Another friend has a major surgery at a time when he had no insurance... he paid about 1/4 of the bill and then the rest was taken care of by a donation to a fund for people without insurance. It's worth a try to ask.

I'm glad your Mom is helping with some of the cost.... did I say Insurance sucks!

hawkshoe replied: Personally, I can understand why insurance companies don't cover specialized foods. I can also understand your frustration at the cost.

Having worked in the insurance business for years, I would say to give up that battle, you will not win it. Instead concentrate your efforts elswhere. Start with your pediatrician and try to get free samples from him. Next send a letter to the formula manufacturer and try to see if they can give you the formula at a discounted rate. You might also consider checking with the seller to see if they will give you a discount if you buy so many cans at a time.

lovemy2 replied: I don't know how you feel about this but try ebay - there is tons of formula for sale there and if they are factory sealed, etc........

flirtycuddle replied: What formual is it? I know my son is on neocate and it is freaking expensive big time. If it is neocate go to www.neocate.com and click on insurance help. Also if it is neocate try calling APRIA health care and talk to them about how much it is and and how insurance wont pay for it. I dont know if i am allowed ot post it onhere but pm and Ill give you a link to a website that has a ton of resources to help pay for formula like the elemental ones. Just pm and ill give you the info that i have. Ive been through it and i know it sucks.

MommyToAshley replied:
It's no problem for you to post the link... others may benefit from it as well.

It's spam links and self-promotion that we don't allow links.

flirtycuddle replied: I just pmed her with the link to the specific site but here it is agian in case some one else needs it. This is for elecare http://www.ross.com/healthcare/default.asp click on the bottom link that says patient assistance program. I found it on another site i am apart of specifiaclly for kids with allergies. I know APRIA health care is a medical supply company also that if you call and say you're child is in an elemental formula and then explain the insurance they will try and help out by giving it a discounted price or one family had it covered for htem. I dont know if apria is anywhre else other then AZ and NV but worth a shot.