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.