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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:
    1. Letter of medical necessity
    2. Medical documentation
    3. 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@medicalfood.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.