Helpful Tips for Successful Reimbursement
What you can do
- Make sure your submission is complete and follows your insurance company’s guidelines.
- Be persistent
- Consider providing the following:
- Letter of medical necessity
- Medical documentation
- Definition of medical food and exempt infant formula
- Ask to speak to a nurse case manager in your insurance company and don’t stop with customer service.
- Utilize all the appeals levels, 1st, 2nd, 3rd, Grievance. Write down every person that you have spoken to and what they have said on each date.
- Find out the process for utilizing your mail order prescription program (if you have one).
- Try get it through your mail order benefit by following the sample procedure you would for other medications
- Use FSA (Flexible Spending Account) dollars to pay for the formula (if your employer has one).
- Contact the Nutricia Coverage Department for added assistance. Call 800-605-0410 or email Coverage@Nutricia.com
What your physician can do
- Provide a letter of medical necessity from the physician including the following facts:
- Detailed diagnosis including but not limited to growth charts and documentation about the progress of the patient;
- Provide lab results where applicable;
- Argue that nutritional therapy is more cost effective and in many cases even medically more effective than other alternatives (e.g. tube feeding); and
- The more detailed the information the better the chances for reimbursement.