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05-30-2017, 08:40 AM   #1
Senior Member
Join Date: Jul 2016

Good morning. Does anyone here has experience with getting nutritional drinks covered by health insurance? Dme versus prescription coverage and cost.
05-30-2017, 11:17 AM   #2
my little penguin
Forum Monitor
Join Date: Apr 2012

My Support Groups:
Under the durable medical equipment clause
Formula is infusion therapy supplies
Your durable medical equipment company has an insurance department
Your GI should be able to write a letter if medical necessity
Then the insurance may cover it

I am not aware of anyone who has prescription plan cover formula for Crohns

Some insurance will only cover through Dme if it's sole nutrition and tube feed
Others just cover it
DS - -Crohn's -Stelara -mtx
05-30-2017, 12:14 PM   #3
Senior Member
Join Date: Jul 2016
Thank you for responding. My primary insurance does not cover the drinksame through dme.
05-30-2017, 12:32 PM   #4
my little penguin
Forum Monitor
Join Date: Apr 2012

My Support Groups:
You still need to call the Dme
Our insurance said no they were not covered
The Dme folks had there own insurance gurus
Who worked with the doc and got it covered
05-30-2017, 12:53 PM   #5
Tesscorm's Avatar
Join Date: Jun 2011
Location: Ontario

My Support Groups:
I don't know where you're located but, in Toronto, I had the formula covered under a regional medical agency. They covered the equipment rental, tubes, formula and regular nurse visits.

My insurance did not cover the formula.
Tess, mom to S, 22
Diagnosed May 2011

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

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