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Crohn's Disease Forum » Treatment » Enteral Nutrition & TPN » Enteral feeds: Does U.S. insurance pay?


06-24-2012, 07:10 AM   #1
xmdmom
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Enteral feeds: Does U.S. insurance pay?

I'm wondering if there's anyone from the U.S. who knows if insurance pays for enteral feeds (by mouth or by ng tube) for children or adults.

My son is 19 and recently diagnosed with Crohn's. We're wondering if enteral feeding might be an option for him.

Thanks!

Last edited by xmdmom; 06-24-2012 at 08:49 AM.
06-24-2012, 09:45 AM   #2
my little penguin
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Ours does for my 8 year old.

You need to have the doc write a script and letter of medical necessity. The doc need to send the script through the durable medical equipment company (DME).
Most insurances have a DME clause where they will cover X% after a deductible is met.

You can also order on your own through:
http://www.nestlenutritionstore.com/...=digestive.3.1

http://abbottnutrition.com/Adult/Adu...-Products.aspx

https://www.neocate.com/shop/c-6-nutricia-category.aspx

there are discounts for auto reorder etc..
Most GI's will give you samples to try or call the company directly for samples

Good luck
06-27-2012, 08:15 AM   #3
Tesscorm
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Join Date: Jun 2011
Location: Ontario

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We're in Canada but, our experience has been that neither our provincial healthcare nor our private insurance will cover the formula (insurance company considers it only a nutritional supplement.) However, since his diagnosis, a local/regional medical agency has been covering the cost of the formula plus equipment.
__________________
Tess, mom to S, 22
Diagnosed May 2011

Treatment:
May-July 2011 - 6 wks Exclusive EN via NG tube - 2000 ml/night, 1 wk IV Flagyl
July 2011-July 2013 - Supplemental EN via NG, 1000 ml/night, 5 nites/wk, Nexium, 40 mg
Feb. 2013-present - Remicade, 5 mg/kg every 6 wks
Supplements: 1-2 Boost shakes, D3 - 2000 IUs, Krill Oil
06-27-2012, 02:39 PM   #4
xmdmom
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I'm not sure what a local/regional medical agency would be. I can't think of an equivalent in the U.S.
07-15-2012, 12:14 AM   #5
Tenacity
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An equivalent in the US would be Aprial Healthcare. Call them and get their fax number, and have your doctor fax them the prescription along with your insurance details. Tell them it is his sole source of nutrition - as some medical insurance companies only cover the cost of the formula if it is the patients sole source of nutrition. A good formula to try for someone in your son's age group is Peptamen or Peptamen 1.5 if you would like some extra calories. If he is flaring, I would start out on an exclusive elemental diet (set the pump on a lower rate if you do not see any improvement - start off slow, and increase the rate), and then slowly re-introduce foods, but always keep the elemental drinks as part of his nutrition. Here is a study I would like to share with you, which discusses the efectiveness of a half elemental diet:

http://www.ncbi.nlm.nih.gov/pubmed/17059514

Eventually, he could eat food, and just drink the formulas orally during the daytime. I would add some water to the formula if he drinks them orally, to lower the osmolarity level.

Last edited by Tenacity; 07-15-2012 at 12:31 AM.
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