Hi, I need some input into this Prescription food thing I have seen posts on. Some people get their food delivered to them the same as other medical supplies that come from the hospital.I was just in the hospital and I am pureeing my food , but next step, I get the PEG tube again. I asked the nutritionist can I get food by prescription for the PEG? She looked blank , then said what insurance do you have? I told her. She said they do not like to do that ,it is just food. No it is not just food, it is expensive compared to regular food and I would not be using it if it were not for my medical condition. I said are you telling me if my Doctor writes a prescription for this The hospital pharmacy will not deliver it with the rest of my stuff??? Now they push a name brand of this food, is that the deal????Why are some people getting free food and others not?How many of you have gotten their food this way?I think I rocked the boat with this one at my hospital. Any suggestions on how I move forward with this.gnelson :rolleyes:

I lived off of Ensure for the better part of a year. Blue Cross paid for the canned supplements...or I should say they paid for part of it, since I was being treated outside my service area. This is a whole 'nuther issue that we can explore further in another post. What you need to do is get the insurance claim adjuster on the phone, with your Rx from your doctor for your liquid food in hand, and get through to them that this is not considered normal meals, but a prescription based diet that you are be dictated into eating to stay alive. They should also be covering your PEG system and replacement parts, bags etc. By pass that nutritionist and ask your doctor for a prescription. It is no skin off of him to write you one. He surely knows that you can't eat regular food. If you do not get results, tell them the next call will be to the state insurance commissioner. You need a Rx from your doctor to get them off of their butts. I fought with Blue Cross for months

gnelson,

Brian is right. Bypass the nutritionist and call your insurance company directly. We also live in Pennsylvania and my daughter has Keystone HMO. They didn't even question it. One call from the hospital and they had cases of Ensure delivered to the house the day she came home from the hospital.

Of course, it depends on what insurance you have, but it also depends on your health team. Anyone dealing with cancer patients on a regular basis should know how to get you what you need. If, for some reason, your ins. co. won't cover it, have you had any help from the American Cancer Society? They helped Heather with some of the cost of her Zofran prescription. That's the anti-nausea med for the amifostine that costs $26 per pill.

Anyway, we were told they only give $75 per month, but that you can get 3 months worth at one time. The nurse at the radiation center took care of everything. We didn't have to do anything except pay our portion and tell the nurse what pharmacy we used. They paid $225 directly to the pharmacy. I would think they would help pay for the Ensure also. They use a voucher system, so you could probably get the Ensure anywhere that accepts the vouchers. Someone on your oncology team should know how it all works.

Good luck,

Rosemary

Well stated Brian! Seems to be the MO of most Ins. Co's. I personally think if you go one up to BC and/or if you have an HMO, the HMO/Department of Managed Health Care for your state, along with the Ins Commission for your state, utilizing those agencies and going to the top, should your ins carrier not wish to comply with your needs for survival through this would be the best route.

Just this past week or so I found out that active advocating for yourself and your needs is sometimes very necessary. I have recently had to advocate for myself to get my HMO ins. plan to allow me to go close to home for further specialty work up's, eval and treatment. I guarantee you that if you were living in California and were struggling with an HMO you could get results, and within 24 -48 hours. Just start pressing those numbers on your phone...

It warms my heart to know Mama was right when she said "if you want to really get something done, bypass the in-between and go to the top!" It worked for me.

My stuff is called Ultracal, and it was prescribed by the dietician at MD Anderson. Anderson initially gave me a few cases, but now I just call the Home Patient company and ouila, a guy in a van shows up with cases of the stuff. I guess the insurance company is paying. I also have Blue Cross and even though I was only diagnosed in July, I have used up my $1500 for prescriptions. Last time I got duralgesic pain patches I had to pay $400 out of my pocket. I am not sure if this stuff is considered like a prescription or as a necessary part of treatment.

Danny G.

Hi! my name is leonor I read your post abt a script for supplements.My husband is totally dependent on his peg tube,when he came home from the hospital the medical supply company delivered 10 cases of osmolite and it didn't agree with him.I called the dr and he told me to try over the counter supplements,easy for him to say it costs abt $80 a wk, and he can afford it.I called him on numerous occassions for a new script for ensure and he said ins companies don't have to pay for his food.Finally after 6 requests his office faxed a script for ensure plus to the medical supply company and they called the ins company authorizations dept, and the next day 10 cases were brought with a refill of 6 x's on the script. So keep pushing alot of ins companies will pay,but only for certain brands.

Good Luck

Gnelson..........My insurance Co. also refused to pay for my liquid food, Jevity. But after one nasty note from my Internist the Insurance Co. was more than happy to pick up the expense. Good Luck! Sincerely, Donna

Hi, I read these posts real quickly yesterday morning before I left to get my stitches out. By pass her ass ,is probably the best advice I have had in a long time. I asked my ENT why people from New England to Calif. were getting their PEG food tube paid for if a physician wrote a prescription . He looks at his resident and says take care of this for her! After he left the resident and I were going over my new operation information and he said he would get working on it for me to get the food. The hospital deliverys all my other equiptment. I said do you think this will work? Oh yes, we will get it for you.I wish I had know this the first time around.This is a matter of knowing who to ask.You guys all helped me save some money I can well use for other things! Thanks.Happy Thanksgiving!

gnelson,

That's great news! So glad it all worked out for you. Happy, Happy Thanksgiving everyone.

Rosemary

P.S. Heather has been feeling better these last 2 days. No more nausea. So it will be a Happy Thanksgiving!

I`m on jevity plus, which I get 6 cases at a time from medical supply company........medicare pays 60 percent........I owe them about 1500 dollars by now, but thankfully they keep sending it..Packer