Tuesday tips: Getting formula covered by insurance

Happy Tuesday everyone!

I’ve talked about how B had acid reflux and MSPI, and how it’s often helpful to try a dairy (and soy) free diet to alleviate some of the symptoms for babies who have this.  I tried a dairy/soy free diet for B, and unfortunately it did not help ease the pain he was having from reflux.  Some moms go on a total elimination diet to try to pinpoint what exactly in their diet is causing baby’s pain/issues.  Because B was in so much pain, I just wasn’t willing to use him as a science experiment and, through trial and error, figure out what exactly was causing his reflux.  So we opted for formula- there are two types of formula that are made to help babies with MSPI- hypoallergenic formulas (like Nutramigen or Alimentum) or amino acid formulas (like Neocate, Elecare, Nutramigen AA).

hypoallergenic formula


A hypoallergenic formula has the milk and soy proteins broken down so that they are easier for baby to digest (and their body doesn’t react to them).  Amino acid formulas have all the proteins broken down into amino acids, so it is as gentle as it can possibly be for baby’s tummy.  A lot of people have great luck with these formulas.  We had the most success with Neocate, and B is still drinking that today.


amino acid formula


The downside to these formulas is their cost.  Nutramigen or Alimentum costs up to $30 for a can (which would last us 2-3 days).  Neocate or Elecare costs $50-90 a can, depending on where you buy it (and again a can lasts 2-3 days).  That means you can potentially spend almost $1000 a month on formula.  We all know babies are expensive, but the added cost of these formulas is not always something people expect.

When we realized that B was going to do the best on Neocate, I did everything in my power to figure out how to avoid paying $1000 a month for formula.  Neocate is a prescription only formula, so the first thing I did was I went to our pharmacy to fill the prescription.  They filed the information with my insurance…who flat out denied me.  Ugh.

However, I was a mom on a mission.  After a lot of time on the internet and the phone, I figured out how to get our formula covered by insurance.  Unfortunately, because not everyone has the same insurance, what worked for me MAY NOT work for you- but I say, it’s worth a shot.  The worst thing they’re going to say is no.  (I’m adding in the disclaimer that I am in NO WAY compensated by this company- they have absolutely no idea who I am)

Here is what I suggest to hopefully get your formula covered by insurance:

  1. Have your pediatrician write you a script for the formula (and this can be for Nutramigen/Alimentum, not just Neocate/Elecare) and make sure they state that the formula is medically necessary due to a severe milk allergy.
  2. Call Edgepark Medical, a durable medical supply company- 888-394-5375.  Note: You can go online, but the best way to ensure you get your formula covered is to call.
  3. Set up an account with them, and place an order for your formula of choice- I know for sure that they carry Nutramigen, Alimentum and Neocate.
  4. They will contact your insurance company and your pediatrician.  It can take up to a week to get all of your information verified, but after that, if you haven’t heard back from them, call to check on your order.
  5. Depending on your insurance, they will hopefully cover the formula at least partially, but there is the possibility that they will cover it 100%.

I really hope that this tip helps some moms out!!



2 thoughts on “Tuesday tips: Getting formula covered by insurance

  1. I’m glad you found a solution to ensure your child gets the best formula to help his reflux. It’s bad enough having to worry about one’s child and then have the added pressure that what will help them also costs a fortune!


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