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What insurance company do you have, I tried to get my insurance to cover it, had a prescription and went through a medical company and my insurance denied the claim.
I have United Health Care with Medco prescription coverage. The trick I found was to get it through my mail order pharmacy so that the prescription coverage picked it up, not medical. To get it covered through medical I've been told to go through a medical supply company so that it can be billed as medical food. If you google it online, you can find medical supply companies that will help you get it covered as medical food and know all too well how to deal with insurance red tape. Also try calling your insurance or prescription company and asking what diagnosis or circumstances allows them to cover it. I ended up going directly through Medco and got it covered immediately. (My insurance was just giving me grief.) The diagnosis that they excepted was "Fussy Baby". I received 31 cans of powder Alimentum (3 month supply) with such a simple diagnosis!!!
Insurance and prescription companies perfer for you to have a script for the powder versus any liquids. Powder formula will also cost you a lower co-pay. I pay $20 for a 3 month supply of powder versus $60 for a supply of liquid.
What state do you live in? Ohio you can get it without an RX because they cover ALL similc. I never had to get an RX for Isomil and I was told I had to. Best bet is to call your health department.
I have exactly the same insurance and prescription coverage that you do. Can you please explain what I need to say so that I can get the Alimentium? This formula is killing us financially as my son finishes one can in two days.
My insurance doesn't cover it, but my flexible spending account did agree to cover it with a doctors prescription. It's not much, but does help.
I don't know if your insurance approved your request, but just thought to let you know that Walmart has Alimentum on sale for about $7 for the 1QT Liquid formula, they are not advertising it, and when I asked the cashier if its on sale she said she doesn't know. It's a $3 saving, worth a trip to your local Walmart to check if its also on sale.
I don't know how the rules are in every state but here in Texas they will approve all the similac formula's with out an RX but the Alimentum I had to get a RX for this and here in Texas I do get the WIC for my son but it isn't enough to cover the whole mth I am finding myself having to buy it.
First of all, I would like to thank you for this post, about 2 weeks ago I came across this post and immediately called my insurance to find out if they will cover Alimentum. I had no idea that insurance might pay for the formula that my daughter has been on for over 5 months now. Now two weeks later they approved it and it will be covered 100% and I should be receiving a delivery from Apria Health care today with one month supply :)
Like many others have said keep calling your insurance and do not give up if one person tells you no, because from my experience the customer reps do not know a whole lot. Most times I felt like they were guessing and sometimes I even got different answers from different people. Try to see if you can get someones direct line and keep checking on the status everyday.
By the way my insurance is Empire BlueCross BlueShield and they did require a prescription from my daughter's ped. which stated the medical necessity for why she needs Alimentum. Hope you get an approval from your insurance soon....good luck
One more thing I would suggest for everyone is to contact the company. They sent me samples and extra coupons that help a great deal while I waited for delivery. I wouldn't have made it without the help of Abbott. Please use them as a resource. They made me feel like they were interested in my family and not the profit margin.
If you have a Buy Buy Baby store by you they charge $6 for the ready to feed bottles and Similac sends you the $5 off coupons and it would end up about $1 per Bottle. Thats what I do and it works really well for us. Good luck and I hope you have a Buy Buy Baby close to your home.
i will try that ! thanks
My first child was on Alimentum and he was on WIC. I had a Dr. prescribe it and gave that to WIC and they paid for it until he was no longer on it (at 1year). Now with my youngest who is 16 months he was on Isomil Soy from birth which requires no prescription from a Dr. Now that he is too old for formula I switched him to cow's milk with him having diarrhea for a month straight. So I tried lactose free milk for a week and that didn't work. Then I tried soy milk and that helped somewhat. But a half gallon of Soy milk costs as much as a gallon of regular. He was still getting WIC but we were drinking the cows milk and buying him soy and he was going through it FAST! So I have been told by WIC that they will provide soy milk if I have a DR.'s note and they just started doing this in October. I switched insurances and now I have to find a new Dr. In the mean time I have tried the toddler formulas and have been getting better results from them, The only problem was that they are all milk based. But he was doing better on those than with the soy milk. So last night I discovered that Similac has a toddler formula that is soy based. It's all just confusing and with not having a Dr. it makes all that much more difficult. Sorry just needed to vent I guess.
My insurance company says they will not cover Alimentum, even with a prescription, because they don't cover anything that can be purchased without a prescription. Has anyone else run into this? I'm so bummed!
My son was started on Alimentum and the Doctor"s office had some available at the time to get me started.. It helped a great deal but no one else has needed it.. So check for samples of it around the area also..