Blue Cross Blue Shield...now its WAR

[jimiv]

Well Parker had his G-tube put in yesterday and by all accounts it went well. I was a little concerned that the Surgeon, Pulmonologist, and Gastrologist were not on the same page on how long Parker was going to be in the hopsital. He is going to be discharged today and spend the rest of the weekend with his mother. Just when it looked like things were going to settle down....enter managed care. They will pay for the pump, tubes, bags, and all the hardware. What they will not pay for is the supplements. The current bill at the initial diet they are setting for Parker would come out to $1,300.00 a month (where did I put that winning powerball number). I am starting to frame my appeal and argument to BC/BS of Louisiana. Does anyone have suggestions about a good route to take with them? Also does anyone have any options or suggestions of feeding options? Currently they are recommending some stuff called Peptamin Jr. We already get Scandishake powder for free because we use Ultrase as enzymes. Would this work as well? I am looking for options that have the best nutrition for Parker and secondly, things that will work with managed care or I can make myself at a lower cost. Any and all ideas would be helpful.

 

[jimiv]

Well Parker had his G-tube put in yesterday and by all accounts it went well. I was a little concerned that the Surgeon, Pulmonologist, and Gastrologist were not on the same page on how long Parker was going to be in the hopsital. He is going to be discharged today and spend the rest of the weekend with his mother. Just when it looked like things were going to settle down....enter managed care. They will pay for the pump, tubes, bags, and all the hardware. What they will not pay for is the supplements. The current bill at the initial diet they are setting for Parker would come out to $1,300.00 a month (where did I put that winning powerball number). I am starting to frame my appeal and argument to BC/BS of Louisiana. Does anyone have suggestions about a good route to take with them? Also does anyone have any options or suggestions of feeding options? Currently they are recommending some stuff called Peptamin Jr. We already get Scandishake powder for free because we use Ultrase as enzymes. Would this work as well? I am looking for options that have the best nutrition for Parker and secondly, things that will work with managed care or I can make myself at a lower cost. Any and all ideas would be helpful.

 

[jimiv]

Well Parker had his G-tube put in yesterday and by all accounts it went well. I was a little concerned that the Surgeon, Pulmonologist, and Gastrologist were not on the same page on how long Parker was going to be in the hopsital. He is going to be discharged today and spend the rest of the weekend with his mother. Just when it looked like things were going to settle down....enter managed care. They will pay for the pump, tubes, bags, and all the hardware. What they will not pay for is the supplements. The current bill at the initial diet they are setting for Parker would come out to $1,300.00 a month (where did I put that winning powerball number). I am starting to frame my appeal and argument to BC/BS of Louisiana. Does anyone have suggestions about a good route to take with them? Also does anyone have any options or suggestions of feeding options? Currently they are recommending some stuff called Peptamin Jr. We already get Scandishake powder for free because we use Ultrase as enzymes. Would this work as well? I am looking for options that have the best nutrition for Parker and secondly, things that will work with managed care or I can make myself at a lower cost. Any and all ideas would be helpful.

 

[jimiv]

Well Parker had his G-tube put in yesterday and by all accounts it went well. I was a little concerned that the Surgeon, Pulmonologist, and Gastrologist were not on the same page on how long Parker was going to be in the hopsital. He is going to be discharged today and spend the rest of the weekend with his mother. Just when it looked like things were going to settle down....enter managed care. They will pay for the pump, tubes, bags, and all the hardware. What they will not pay for is the supplements. The current bill at the initial diet they are setting for Parker would come out to $1,300.00 a month (where did I put that winning powerball number). I am starting to frame my appeal and argument to BC/BS of Louisiana. Does anyone have suggestions about a good route to take with them? Also does anyone have any options or suggestions of feeding options? Currently they are recommending some stuff called Peptamin Jr. We already get Scandishake powder for free because we use Ultrase as enzymes. Would this work as well? I am looking for options that have the best nutrition for Parker and secondly, things that will work with managed care or I can make myself at a lower cost. Any and all ideas would be helpful.

 

[jimiv]

Well Parker had his G-tube put in yesterday and by all accounts it went well. I was a little concerned that the Surgeon, Pulmonologist, and Gastrologist were not on the same page on how long Parker was going to be in the hopsital. He is going to be discharged today and spend the rest of the weekend with his mother. Just when it looked like things were going to settle down....enter managed care. They will pay for the pump, tubes, bags, and all the hardware. What they will not pay for is the supplements. The current bill at the initial diet they are setting for Parker would come out to $1,300.00 a month (where did I put that winning powerball number). I am starting to frame my appeal and argument to BC/BS of Louisiana. Does anyone have suggestions about a good route to take with them? Also does anyone have any options or suggestions of feeding options? Currently they are recommending some stuff called Peptamin Jr. We already get Scandishake powder for free because we use Ultrase as enzymes. Would this work as well? I am looking for options that have the best nutrition for Parker and secondly, things that will work with managed care or I can make myself at a lower cost. Any and all ideas would be helpful.

 

[Buckeye]

We have United HealthCare and it is a fight every year to get the food part covered. Our plan specifically says it will not cover any enteral feeding products no matter what, but we have successfully gotten a waiver from them saying they will pay for it in our son's case. The agency that negotiates my husband's company's insurance coverage are the people that have fought to get it covered and they use the thought that if he does not get the nutrition he needs then it will result in increased medical costs for the insurance company - more hospital stays, etc. I would think with your son being under weight it would greatly affect his lung function and ability to fight off infections, etc. so you might want to try that theory. Regarding type of formula, you would want to run that by your son's GI doctor and Nurtitionist. At least with my son they are extremely picky about what formula he is on and have specific reasons why they choose what they do. Different formulas have different levels of fat, carbs, vitamins, calories, etc so it's not like they are all the same. Lastly, if you are able to switch to Pediasure I know Walgreens, Walmart, CVS etc all have their own versions of it that are much cheaper than the namebrand Pediasure.

 

[Buckeye]

We have United HealthCare and it is a fight every year to get the food part covered. Our plan specifically says it will not cover any enteral feeding products no matter what, but we have successfully gotten a waiver from them saying they will pay for it in our son's case. The agency that negotiates my husband's company's insurance coverage are the people that have fought to get it covered and they use the thought that if he does not get the nutrition he needs then it will result in increased medical costs for the insurance company - more hospital stays, etc. I would think with your son being under weight it would greatly affect his lung function and ability to fight off infections, etc. so you might want to try that theory. Regarding type of formula, you would want to run that by your son's GI doctor and Nurtitionist. At least with my son they are extremely picky about what formula he is on and have specific reasons why they choose what they do. Different formulas have different levels of fat, carbs, vitamins, calories, etc so it's not like they are all the same. Lastly, if you are able to switch to Pediasure I know Walgreens, Walmart, CVS etc all have their own versions of it that are much cheaper than the namebrand Pediasure.

 

[Buckeye]

We have United HealthCare and it is a fight every year to get the food part covered. Our plan specifically says it will not cover any enteral feeding products no matter what, but we have successfully gotten a waiver from them saying they will pay for it in our son's case. The agency that negotiates my husband's company's insurance coverage are the people that have fought to get it covered and they use the thought that if he does not get the nutrition he needs then it will result in increased medical costs for the insurance company - more hospital stays, etc. I would think with your son being under weight it would greatly affect his lung function and ability to fight off infections, etc. so you might want to try that theory. Regarding type of formula, you would want to run that by your son's GI doctor and Nurtitionist. At least with my son they are extremely picky about what formula he is on and have specific reasons why they choose what they do. Different formulas have different levels of fat, carbs, vitamins, calories, etc so it's not like they are all the same. Lastly, if you are able to switch to Pediasure I know Walgreens, Walmart, CVS etc all have their own versions of it that are much cheaper than the namebrand Pediasure.

 

[Buckeye]

We have United HealthCare and it is a fight every year to get the food part covered. Our plan specifically says it will not cover any enteral feeding products no matter what, but we have successfully gotten a waiver from them saying they will pay for it in our son's case. The agency that negotiates my husband's company's insurance coverage are the people that have fought to get it covered and they use the thought that if he does not get the nutrition he needs then it will result in increased medical costs for the insurance company - more hospital stays, etc. I would think with your son being under weight it would greatly affect his lung function and ability to fight off infections, etc. so you might want to try that theory. Regarding type of formula, you would want to run that by your son's GI doctor and Nurtitionist. At least with my son they are extremely picky about what formula he is on and have specific reasons why they choose what they do. Different formulas have different levels of fat, carbs, vitamins, calories, etc so it's not like they are all the same. Lastly, if you are able to switch to Pediasure I know Walgreens, Walmart, CVS etc all have their own versions of it that are much cheaper than the namebrand Pediasure.

 

[Buckeye]

We have United HealthCare and it is a fight every year to get the food part covered. Our plan specifically says it will not cover any enteral feeding products no matter what, but we have successfully gotten a waiver from them saying they will pay for it in our son's case. The agency that negotiates my husband's company's insurance coverage are the people that have fought to get it covered and they use the thought that if he does not get the nutrition he needs then it will result in increased medical costs for the insurance company - more hospital stays, etc. I would think with your son being under weight it would greatly affect his lung function and ability to fight off infections, etc. so you might want to try that theory. Regarding type of formula, you would want to run that by your son's GI doctor and Nurtitionist. At least with my son they are extremely picky about what formula he is on and have specific reasons why they choose what they do. Different formulas have different levels of fat, carbs, vitamins, calories, etc so it's not like they are all the same. Lastly, if you are able to switch to Pediasure I know Walgreens, Walmart, CVS etc all have their own versions of it that are much cheaper than the namebrand Pediasure.

 

[jacksmom]

I would look into disability for your son. We did for my son that has a G-Tube and also is on Peptamen Jr.
Because my son was listed as disabled we got medicare for my son and since we have that we also have WIC (a state program that helps pay for food for low income familys or familys that are on Medicare) Between WIC and medicare we get enough cans every month.
We also have United Health Care and were unable to get them to cover the Peptamen Jr. or the Elecare my son was on before the Peptamen.

Good Luck
Carey

 

[jacksmom]

I would look into disability for your son. We did for my son that has a G-Tube and also is on Peptamen Jr.
Because my son was listed as disabled we got medicare for my son and since we have that we also have WIC (a state program that helps pay for food for low income familys or familys that are on Medicare) Between WIC and medicare we get enough cans every month.
We also have United Health Care and were unable to get them to cover the Peptamen Jr. or the Elecare my son was on before the Peptamen.

Good Luck
Carey

 

[jacksmom]

I would look into disability for your son. We did for my son that has a G-Tube and also is on Peptamen Jr.
Because my son was listed as disabled we got medicare for my son and since we have that we also have WIC (a state program that helps pay for food for low income familys or familys that are on Medicare) Between WIC and medicare we get enough cans every month.
We also have United Health Care and were unable to get them to cover the Peptamen Jr. or the Elecare my son was on before the Peptamen.

Good Luck
Carey

 

[jacksmom]

I would look into disability for your son. We did for my son that has a G-Tube and also is on Peptamen Jr.
Because my son was listed as disabled we got medicare for my son and since we have that we also have WIC (a state program that helps pay for food for low income familys or familys that are on Medicare) Between WIC and medicare we get enough cans every month.
We also have United Health Care and were unable to get them to cover the Peptamen Jr. or the Elecare my son was on before the Peptamen.

Good Luck
Carey

 

[jacksmom]

I would look into disability for your son. We did for my son that has a G-Tube and also is on Peptamen Jr.
Because my son was listed as disabled we got medicare for my son and since we have that we also have WIC (a state program that helps pay for food for low income familys or familys that are on Medicare) Between WIC and medicare we get enough cans every month.
We also have United Health Care and were unable to get them to cover the Peptamen Jr. or the Elecare my son was on before the Peptamen.

Good Luck
Carey

 

[julie]

Do you have a formal denial? I'd be really interested in their denial reasons. I ask because 3-4 years ago I started a 2 year appeal process with Tricare Insurance, and after a handful of appeals (I think it was 4) and a hearing before a federal judge, I finally won our case.

I'd have to know their basis for the denial (i.e. what their rules and regulations state about supplemental nutrition, what their rules/regs say about pumps, tubes and bags....) Do you have a handbook or website for BCBS that you can get this info from.

I'd be happy to help you draft an appeal if you can provide me with the aforementioned information.

 

[julie]

Do you have a formal denial? I'd be really interested in their denial reasons. I ask because 3-4 years ago I started a 2 year appeal process with Tricare Insurance, and after a handful of appeals (I think it was 4) and a hearing before a federal judge, I finally won our case.

I'd have to know their basis for the denial (i.e. what their rules and regulations state about supplemental nutrition, what their rules/regs say about pumps, tubes and bags....) Do you have a handbook or website for BCBS that you can get this info from.

I'd be happy to help you draft an appeal if you can provide me with the aforementioned information.

 

[julie]

Do you have a formal denial? I'd be really interested in their denial reasons. I ask because 3-4 years ago I started a 2 year appeal process with Tricare Insurance, and after a handful of appeals (I think it was 4) and a hearing before a federal judge, I finally won our case.

I'd have to know their basis for the denial (i.e. what their rules and regulations state about supplemental nutrition, what their rules/regs say about pumps, tubes and bags....) Do you have a handbook or website for BCBS that you can get this info from.

I'd be happy to help you draft an appeal if you can provide me with the aforementioned information.

 

[julie]

Do you have a formal denial? I'd be really interested in their denial reasons. I ask because 3-4 years ago I started a 2 year appeal process with Tricare Insurance, and after a handful of appeals (I think it was 4) and a hearing before a federal judge, I finally won our case.

I'd have to know their basis for the denial (i.e. what their rules and regulations state about supplemental nutrition, what their rules/regs say about pumps, tubes and bags....) Do you have a handbook or website for BCBS that you can get this info from.

I'd be happy to help you draft an appeal if you can provide me with the aforementioned information.

 

[julie]

Do you have a formal denial? I'd be really interested in their denial reasons. I ask because 3-4 years ago I started a 2 year appeal process with Tricare Insurance, and after a handful of appeals (I think it was 4) and a hearing before a federal judge, I finally won our case.

I'd have to know their basis for the denial (i.e. what their rules and regulations state about supplemental nutrition, what their rules/regs say about pumps, tubes and bags....) Do you have a handbook or website for BCBS that you can get this info from.

I'd be happy to help you draft an appeal if you can provide me with the aforementioned information.