What to Know About Coverage
Options for Families That Cannot Afford Costly Medical Foods
Researchers estimate that 1 in every 13 children, roughly two in every classroom, suffer from severe health conditions. Most of these children are unable to consume a natural diet and are dependent on specialized, costly medical foods and formulas. The average cost to provide medical foods and formulas can range from $3,000 to $5,000 a year. As startling as these statistics are, consider the number of families that are not only devastated financially, but mentally and physically by these diseases and conditions.
CMNuA understand the challenges and financial burden bore by families. The process of obtaining medical foods and formulas can be frustrating. Special medical foods are costly because they cannot be purchased at the grocery store since they must be used under medical supervision. Here are some ways to help you understand your options and keep costs down.
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Check with your insurance provider to see what their guidelines are for attaining coverage and reimbursement. Coverage depends on your insurance plan and where you live. Currently, only 17 states offer some form of reimbursement to families for medical foods and exempt infant formulas.
When applying for coverage you should consider providing a letter of medical necessity (from your child’s doctor) and the legal definition of medical food and exempt infant formula. The more detailed the information, the better your chances are for reimbursement.
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WIC/Medicaid – As with private insurance, every state has their own rules regarding attaining medical foods and other nutritional products through state programs. Contact your state WIC/Medicaid office to see if you are eligible for coverage.
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If you or someone in your family is a uniformed service member covered under Tricare, you may be eligible for assistance or reimbursement. Some medically necessary products are reimbursed through Tricare when prescribed by a physician. Contact your provider’s office for additional information regarding your policy.
Product Assistance Programs
Some companies that make specialized foods and formulas have programs to financially assist disadvantaged families with the cost of purchasing their products. Contact the customer service department to see if the company provides this type of service. Also, check to see if they complimentary samples of their products. This is a smart way to test out a product with your child before purchasing a larger, and probably expensive, quantity.