Formula approval with primary/secondary insurance

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Hello, I am iso advice or a resource to assist my family with getting my sons formula which he receives through his feeding tube.

My four year old son has a rare genetic disorder and has been receiving a specialty formula called Neocate Splash unflavored through his G Tube. We’ve been fighting with his medical supply company, and both insurances to get him this formula again and we finally ran out yesterday. The local children’s hospital have us enough for 4 days but after that we don’t know what to do.

He has Cigna as primary and Medicaid as secondary. The medical supply company refuses to help us at all anymore. We keep getting different stories as to why and who they are trying to Charge. Apparently the MSE believes they haven’t been getting paid by one of the insurance companies which we believed was Cigna. However a rep I spoke with today said it was Medicaid. Our Medicaid rep insists the formula should be 100% covered.

We had Cigna write a denial letter stating they don’t approve of the formula, in hopes of making it easier for Medicaid to be billed. However, the medical supply company says they cannot help us because they would need to bill his primary, Cigna, which will deny it before they can attempt to bill Medicaid.

Even though we have a denial letter from Cigna, the mse says they need to charge Cigna first but will not.

We don’t know what to do, or where to turn. We have been fighting this for months and he ran out of formula once all ready and only has A couple days worth.

I’ve called local hospitals, both insurances, the mse, his nutritionist, and am getting nowhere.

TLDR: we are unable to feed our child because insurance companies and medical supply companies refuse to help.

submitted by /u/lindros88flyers
[link] [comments]
Hello, I am iso advice or a resource to assist my family with getting my sons formula which he receives through his feeding tube. My four year old son has a rare genetic disorder and has been receiving a specialty formula called Neocate Splash unflavored through his G Tube. We’ve been fighting with his medical supply company, and both insurances to get him this formula again and we finally ran out yesterday. The local children’s hospital have us enough for 4 days but after that we don’t know what to do. He has Cigna as primary and Medicaid as secondary. The medical supply company refuses to help us at all anymore. We keep getting different stories as to why and who they are trying to Charge. Apparently the MSE believes they haven’t been getting paid by one of the insurance companies which we believed was Cigna. However a rep I spoke with today said it was Medicaid. Our Medicaid rep insists the formula should be 100% covered. We had Cigna write a denial letter stating they don’t approve of the formula, in hopes of making it easier for Medicaid to be billed. However, the medical supply company says they cannot help us because they would need to bill his primary, Cigna, which will deny it before they can attempt to bill Medicaid. Even though we have a denial letter from Cigna, the mse says they need to charge Cigna first but will not. We don’t know what to do, or where to turn. We have been fighting this for months and he ran out of formula once all ready and only has A couple days worth. I’ve called local hospitals, both insurances, the mse, his nutritionist, and am getting nowhere. TLDR: we are unable to feed our child because insurance companies and medical supply companies refuse to help.
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