Has anyone battled with their insurance co. about formula coverage? My son has a dairy intolerance and there is coverage under our policy for formula and lo and behold I have been battling with Blue Cross for 3.5 months now to actually get them to pay for it. As of today, we have spent $1000 on formula and I'm through the roof p***d off. I spend an hour on the phone with them every other week and it is infuriating.
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I didn't even know that insurance companies covered formula...that is amazing! I hope you're able to resolve it and get some of that money back!
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@FriedBabyMama: Yeah, most do not. But some cover it if it is "medically necessary" which ours was. Our pediatrician told us to expect a check when me son is off to college, haha!
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@winniebee: We have these new "Blue Centers" where you can walk in and talk to a blue cross representative. Maybe try there?
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If you've already gone through the appeals process with the company with no result, contact your state's Division of Insurance. They will file a complaint for you with the company which the company will have to respond to in 30 days or so. Companies usually respond quickly to these complaints to avoid fines.
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@LemonLong: Yeah, we haven't had to appeal yet. Basically BC has been trying to process it as a prescription claim and it's a medical claim and then they say they need X from our pediatrician and when our pediatrician gives it, I follow up in a week and they say they still don't have it. Spinning wheels here, it's awful.
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Yeah we got some money from insurance, but hardly anything. We weren't very persistent, though. Hope you get the money!
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@Andrea: I'm going to persist. Out of principal if nothing else!!!
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@winniebee: Good for you!
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@Andrea: I get SO FIRED up every time I call. I wonder how an uneducated person would navigate this system....
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I heard some insurance companies give you a hard time about covering formula. I guess we were lucky that it took us about 2 months for them to cover it (a lot of back and forth between my son's allergist and United Health Care). And they only start paying for it after they approve it. They didn't cover formula that was already purchased. Hang in there... I'm sure they will cover it. They're just trying to be a pain about it like how all insurance companies like to be.
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@erwoo: Ours covers both ways (can purchase through them and also submit for reimbursement). I'm through the roof annoyed! Glad you got yours covered...
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Crazy that they cover formula!! Sorry they're being a pIta though.. Hope you get your reimbursement soon!
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I'm super annoyed for you!! I hope you get it resolved soon.
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Worst case scenario, if you have enough eligible medical deductions you can claim it on your taxes. That is our plan so we never went through insurance. With MSPI (my son) and Cystic Fibrosis (my husband) we almost always hit the minimum.
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Soooo, I made some threats today (and so did my pediatricain's nurse!!) and I now have the direct dial of SOMEONE in charge of my claim. Hopefully we'll see some benefits in the new year.
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omg $1000 on formula. aghhh!!! that's insane. I'm sorry
I agree it should be covered if medically necessary and I'm sorry they're being ridiculous about it.
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@Mrs. Pen: We have a $500 deductible.....but still, that's $500! And, it blows my mind that we spend $300 per month on formula. BF sooooo much cheaper!
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@winniebee: that's just tragic. Do you wish you had kept pumping? I know that was wearing on you toward the end too!
this is making me feel doubly blessed that BF worked out for us... I wish that was the case for everyone
It almost makes me feel guilty..
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@Mrs. Pen: I just wish that Tyler didn't have the dairy intolerance! I don't wish I kept pumping because I couldn't deal with a full on elimination diet while heading back to work...and pumping full time is just so hard. We barely have time to cook meals as it is and I just know doing elimination would have been even more stressful.
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Winnie- We are with one of the Blues too and it took nearly 9 months to get them to cover M's birth (adoption and all). I pulled every card I could including the doctor schtick and they still tried to resist. It finally recently got paid. If you are persistent you will win!
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@Mrs. Jacks: I pulled the lawyer card today. And told them flat out they wouldn't scare me off and I would call every week for the next year if I had to. My pediatrician's nurse told them they should be ashamed of themselves! I think that they put people off thinking people will just go away....and many times they do. I'm glad that you recently got reimbursed!
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@winniebee: I said the same kind of stuff and they snidely said, "We aren't trying to make this difficult, we just need the right paperwork in place."
I said, "Yeah, right! And if I was a Spanish speaking woman with 3 kids and a full time job, what do you think would have happened?!"
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@winniebee: keep on them!! I so want to see you win this. I hate when companies do exactly that, figure you'll give up and move alone!
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Don't give up! I'm sorry you're having trouble with one of the blues - mine has fantastic customer service. Can your doctor call and give them hell??? If you're covered for this, you ought to be getting it, and without the bs!
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@winniebee: Hang in there! Sometimes you just have to get on their behinds to get them to move things along....
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Persistence will pay off. It took us 14 months to fully resolve one of LO's bills from birth. I finally landed in the hands of an excellent claims handler at UHC who followed through with status calls exactly as she said she would.
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@sarac: Our doctor's nurse gave em hell yesterday!
@MamaG: That's great!
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Well, whaddya know, after some threats yesterday, I just got a call that the request has been APPROVED! Now I have to submit for reimbursement.....which will probably be another set of headaches. But at least it's progress!
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@winniebee: Yay for progress! Good luck!
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Grrr, insurance.... what a pain dealing with insurance companies.. hopefully you get this worked out soon!
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I'm so happy to report that i came home to a big fat check in the mail today...success!!
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@winniebee: yaaaaaay! Congrats!!
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Awesome!!!
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@winniebee: YES!!! That's AWESOME!
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@winniebee: omgosh! Lucky! We haven't even tried yet to claim because we were only on hypoallergenic formula for 3 months so it wasn't too bad. We turned to normal (gentle) formula about 2 weeks ago. But, good for you guys!
I think the TRUE blame is on the formula company. Why the #%^* is the hypoallergenic formula double the price of soy/organic/gentle and all other formulas? That's so corrupt.
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