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July 23, 2008 at 9:42 pm #54370AnonymousInactive
Alright ladies- this is not for me, but for a really cool mom I met through my Cafemom group. She lives in the same city I do in Colorado. Her little girl (one year) has PKU.
Her insurance company WILL NOT pay for her daughters formula. This stuff is so ridiculously expensive ($65 per can). This insurance company doesn’t think its “medically necessary”. People with PKU can’t eat ANY protein whatsoever. I gave her all the links from this forum (“going to the top”) so hopefully she can get somewhere with her insurance. They make just over the limit to qualify for WIC.My question is: I have read (I believe on this forum) that in some states (New York is the one I remember) you can get reimbursed somehow up to a certain $$ amount for foods if you have food allergies or intolerances. My friend spends a ridiculous amount of $$ on fruits and veggies b/c that’s about all her daughter can have besides the formula. There are really specialized foods for PKU, but it’s so expensive. A cake mix for an one 8 inch cake is $28, a box of mac n cheese $7, the same size as a Kraft mac n cheese.Where can I find info to give her about food reimbursement? Is this only in NY or other places also? TIA.July 23, 2008 at 10:41 pm #54373AnonymousInactiveOh KRistin that is a tough one. I am sure she can do an online search for a PKU support group and I bet they will have some links to help with that stuff. That is such a tough disorder to have to live with b/c you are right the diet is so limited. I hope someone else will chime in, but I think you are helping her as much as you can.
July 24, 2008 at 8:18 am #54381AnonymousInactivethat totally sucks Kristin!
I hope that NY does what MD does, which would force her Ins co to cover the formula for her.Has she tried the Apria route (or whatever medical supply co. her Ins co uses?) sometimes that works well. Since usually it is a Medical food that is used and it is stocked with medical supplies. Sometimes if you use that route, the supply co. will call the insurance co and work everything out. This did not work for us but I sure as heck tried!!!! I’ve read that many ppl have had success with it though.You are a good friend for helping her. Tell her to APPEAL APPEAL APPEAL and to write to congress!July 25, 2008 at 9:05 pm #54505AnonymousInactiveYep I would APPEAL APPEAL as well.
My DH HAS PKU and his formula wa covered when he was an infant allt he way through toddlers and teen years. YES< a child with PKU is normally on their milk for that long.It really shoudl get approved. Most insurance co. deny right off the bat hoping that paretns will give up.She needs to have her ped. write up a letter explaing WHAT PKY is and why the formula is medically necesary for his to sustain life. It really is a necessirty tha tshe LIVES off of that formula unto her body is completely DONE growing. If she dones’t it can retard the brain’s growth. -
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