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BlueandGold

Senior member
Joined
Feb 28, 2015
Messages
634
Reason
PALS
Diagnosis
04/2015
Country
US
State
WV
City
Sandyville
Will Medicare pay for formula for the feeds? Been paying out of pocket and it is getting expensive. I haven't been able to find any DME Providers here in WV that provide enteral nutrition. They are all equipment based.

Vince
 
Corum, a specialty division of cvs, supplies it.They have shipped it to us.
 
Als association has grants you could use. If you still eat soft foods or drink with a straw a smoothie with benecal might work.
 
No ALS association in my state. I'll check out the CVS site. I can still eat puréed food but I can no longer use a straw.

Vince
 
Medicare has national contracts; Corum is one, as Steph says.
 
If you are getting at least 50% of your nutrition using your feeding Medicare will pay for it.
Patrick
 
Does Medicare pay for tube feeding formulas? Yes, the formulas and supplies are covered by Medicare Part B and most insurance. Formula won't be covered unless it is the primary source of nutrition and you can't eat well enough to maintain your weight without it. Medicare covers tube feeding formulas if they provide all or the majority of your nutrition. Being able to swallow small amounts of food doesn't disqualify you, but if you still eat most of your meals and just use the tube feeding as a supplement or convenience, Medicare won't cover it.
A form/documentation by your doctor is required for Medicare reimbursement and a diagnosis of ALS covers all the requirements.
Standard tube feeding formulas are covered as well as special formulas needed by diabetics, kidney or liver patients, etc. (Do an internet search for Medicare Part B Enteral Nutrition Reimbursement Manual.pdf. It lists many but probably not all covered formulas.) "Natural" formulas may be covered if your doctor documents an allergy or intolerance of standard formulas. A simple preference for a natural formula isn't covered. The cost of foods and supplements used to make your own blenderized formula is not covered.
As others have said, typical DME providers may not deal with formulas but pharmacies and other outlets may be approved DMEs. Your doctor's office should take care of sending the order to a provider.
If you get formula through a Medicare provider, compare the amount of your copay against the price you would pay buying it yourself online - no prescription needed. Often prices are so jacked up by Medicare approved providers that you end up paying more copay even after Medicare limits the amount Medicare will pay. The provider ends up being paid by Medicare and then again by you, sometimes as much as being double paid the actual cost! Self pay may actually be cheaper if you do some comparison shopping online. It does get expensive but that should be offset by lower grocery bills and a small Medical deduction on your taxes. In fact, I am surprised that Medicare does pay for generic formulas. They certainly don't pay for anyone's groceries!
 
HI Vince,
As already written, Medicare does cover the cost of PEG tube formula. However, If you're having trouble, I do have 12 new cases of Nestle Fibersource that I'm hoping to give someone. If you'd like me to ship it to you, in the event you can't get coverage in time, maybe we can split the shipping cost?

Jen
 
Jen,
Thank you so much for the offer but I can't use products containing soy. My neuro at Duke is currently completing paperwork that we are hoping will qualify us for Liquid Hope. It is very expensive, $200 per week, but is all natural and am hoping, combined with our Vitamix blends will be easier on my digestion. If he documents that I can't tolerate the traditional formulas, we are told Medicare will pay. Fingers crossed. Thanks again for the offer.

Vince
 
I tried almost every formula and wound up using boost plus. It is also covered
 
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