Great news for Texans! On January 1, 2010, a new Texas law went into effect requiring that insurance companies reimburse families for Neocate.
Check out these links for more information:
What is the name of the new law?
HB 2000, an act relating to health benefit plan coverage for certain amino acid-based elemental formulas. The entire law can be found here.
Does this law mean that everyone in Texas will be reimbursed for Neocate?
This law applies to anyone covered by insurance who has received a prescription for Neocate for the management of one of the following conditions*:
- IgE and non-IgE mediated allergies to multiple food proteins;
- Severe food protein-induced enterocolitis;
- Eosinophilic disorders; or
- Impaired absorption of nutrients caused by disorders affecting the absorptive surface, functional length, and motility of the gastrointestinal tract.
The law requires insurance providers to reimburse Neocate whether it is taken orally or via a feeding tube. It applies to Neocate Infant, Neocate Junior, Neocate One+ and E028 Splash.
*Note: Unfortunately, Federal employees, employees receiving insurance through a union and employers who are self-insured are exempt from this law.
When will I get my first reimbursement?
When you get your first reimbursement will vary from family to family.
Insurance companies must begin adhering to this law once you renew your policy with them after January 1, 2010. Therefore, if your policy renews on January 1, 2010 and you purchase Neocate the same day, you’ll be eligible to be reimbursed for that purchase. However, if your insurance policy renews at some point later in the year, your insurance company will not be required to reimburse you until the date of your policy renewal.
The time span from when you submit your paperwork to when you receive your reimbursement will also vary by insurance company/plan.
What can I do to make sure my insurance company reimburses me for the Neocate my child needs?
To try to make sure your first Neocate reimbursement goes as smoothly as possible you can:
- Ask your healthcare provider to draft a letter of medical necessity that includes the following information:
- A detailed diagnosis including, but not limited to, growth charts and documentation about the progress of your child;
- Lab results (if applicable); and
- A statement that nutritional therapy is more cost effective and in many cases even medically more effective than other alternatives (e.g. tube feeding).
The more detailed the information the better. You can also provide your healthcare provider with a sample letter.
- Provide as much Medical documentation as possible, including a copy of the new law.
- Make sure your submission is complete and in accordance with your insurance company’s guidelines.
- Ask to speak to a Nurse Case Manager in your insurance company and don’t stop with Customer Service.
- If you are denied, contact the Neocate reimbursement helpdesk at
neocateinsurance@shsna.com.
- Utilize all the appeals levels, 1st, 2nd, 3rd, Grievance. Write down every person that you have spoken to and what they have said on each date.
Is there any help for me while I wait for my insurance reimbursement?
Yes!
While you await Neocate reimbursement, you can take advantage of a special offer for Texas patients.
You can save $25 off your purchase of any Neocate product by visiting www.orderneocate.com. Use coupon code TXR09 at checkout.*
* Offer may be used only once and may not be combined with any other offer. To receive your discount online, promotion code TXR09 must be entered during checkout. No adjustments to prior purchases allowed. Not valid for cash.
If I don’t live in Texas, how do I get my insurance company to reimburse my Neocate?
The Neocate reimbursement support page has a list of states with similar laws requiring insurance reimbursement of amino acid-based formula.
The same page has valuable tips on insurance reimbursement even if it is not mandated in your state.
If your insurance company refuses to reimburse you for the amino acid-based formula your child needs and you cannot afford it, check out your state WIC agency.
You can also apply for the Neocate Patient Assistance Program.
Texas Legislation in the News
CBS 11 in Dallas, Texas:
http://cli.gs/aG8z6E
Story profiles the Stewart family whose son, Marcus, was born with Smith-Lemli-Opitz syndrome and relies on Neocate formula for his nutritional needs.
The new Texas legislation will have a huge impact on their lives.
What is Neocate?
Neocate, manufactured by Nutricia North America, is the only age-specific, clinically proven, hypoallergenic amino acid-based nutrition effective in the nutritional management of short bowel syndrome (SBS), eosinophilic esophagitis (EoE), cow milk allergy (CMA), gastroesophageal reflux disease (GERD), multiple food protein intolerance (MFPI) and other GI disorders.
You can find more information about the Neocate line of products by visiting: www.neocate.com.