Fight the Fight or Give Up Trying?

I’m at a crossroad and I don’t exactly know what I should do. I feel like I’m chasing after big foot. Three weeks ago Ronny and I switched pediatricians to one who would help get Lukes formula covered by the health insurance company. I got a call today from said insurance company saying that the claim was denied because it was not a medical necessity. I called the doctors office and it seems as if the doctor just went down the list and circled no for every answer….including whether or not he needed the formula to maintain his weight and said there were other options. 

I am so angry right now because he obviously does need the formula. I do not produce enough in a day to feed him one complete meal, and am practically starving myself to make sure the ounce or less he does get in the day won’t make him sick. I don’t know what they expect me to be feeding him. Regular and soy formula makes him sick and he is too small for solids yet. The only option we have is elemental formulas. I guess if you look at it that way, Nutramigen isn’t the only formula option we have: he could be on allimentium or Neocate……but he still needs formula in order to survive.

I was doing a cost comparison and we are currently spending about $250 a month with coupons and enfamil checkers on formula to feed Luke and that’s assuming he finishes every single bottle and none goes to waste. With insurance would be $85 a month. 

I am so sick of having to fight for everything in life. All I want to do is feed my son something that won’t make him sick. I’m heart broken that my body isn’t doing what it should to nourish my baby. It’s so emotionally difficult, I can’t put it into words. Now the insurance company is refusing to help with the cost of formula because they don’t think it’s medically necessary. I feel like we are being punished and forced to jump through so many hoops because I can’t breast feed. 

I am so sick of fighting for everything in life. I will not, however, give up fighting for my son. He deserves nothing but the best. At this point I have a call in to the doctor and spoke to the nurse who was helping us out with the formula. She is going to figure out why the doctor filled the form out the way she did and submit an appeal to the insurance company with the correct information. The doctor isn’t in on amp days so the nurse will get with her first thing Tuesday morning. In the mean time they have enough samples from the rep that came on Friday to get us through a few weeks that I can pick up today. The appeals process could take up to another month by which time we will hopefully have the claim approved and can get the formula delivered before we run out of samples. 

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17 thoughts on “Fight the Fight or Give Up Trying?

    • /shrug I just don’t get it. Worst case we buy the formula and I call the peds office all the time seeing if they have samples. Apparently there are only a handful of babies on the nutramigen in the office and they get tons of it every month. Maybe they’d be willing to help me out with some samples

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  1. I’m so sorry that you’re having a rough go with everything! Of course he medically needs the Nutramigen–why else would you pick that formula? Hopefully that will all get sorted out because it’s so stressful to have to worry about feeding your baby when the options are limited. Our first was on nutramigen for 18 months–again, a medical necessity. However, I never thought to ask insurance to cover it. You are smart!

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  2. I’m sorry that things are still so difficult. At least they’re giving you samples to help get you through. Hopefully they get the appeal going and get it all figured out and approved soon.

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  3. Have you looked into donated breast milk groups on Facebook? Besides the shocking $250 a month formula bill, we could not find one single kind that wouldn’t cause him extreme pain and distress. They ALL hurt him. That’s when I got involved with these nice mamas that share extra…for free. It’s been heavenly since we made the switch! Added bonus: it doesn’t cost anything! But I would gladly pay if I had to because it’s exactly what his little tummy needed.

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    • I have thought about it but with Lukes allergies to cows milk and soy proteins, I don’t trust it enough to put him at risk. He’s doing really well on the nutramigen, the price just kind of sucks

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    • I am in the us. I’m going to blog the process once we get it figured out. Ultimately it’s up to the insurance company, but it has to be a medical necessity they won’t just cover it if you chose to formula feed

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