When speaking with your insurance provider, it helps to use the term enteral nutrition. This refers to nutrition that goes through the gastrointestinal tract, whether taken by mouth or through a feeding tube. Insurance representatives may use this term to distinguish it from total parenteral nutrition, which is delivered through an IV and bypasses the digestive system entirely. Using the correct terminology helps ensure you and the representative are speaking the same language.

You may want to ask the following questions to better understand your coverage options.

Does my policy cover nutrition?

Some insurance policies do not cover nutrition products at all. If this is the case and cost is a concern, please contact us. We may be able to help.

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If formula will be part of my diet but not all of it, does my plan cover enteral nutrition used as a supplement?

Some policies will only cover formula if it is your sole source of nutrition. If you are also eating some solid foods, ask your insurance provider whether they will cover enteral nutrition used for supplemental purposes. It is helpful to clarify whether your formula use will account for less than one hundred percent of your daily calorie needs.

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If you will be drinking formula, does my policy still cover it?

Certain insurance plans may only cover enteral nutrition if it is being used for tube feeding. If you are planning to drink the formula, ask your provider specifically whether your plan includes coverage for oral nutrition. For example, Medicare typically covers formula for tube feeding but not for drinking.

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What percentage of the total cost will my plan cover?

It is important to ask what portion of your prescribed enteral nutrition your plan will pay for. Some plans may cover a large percentage, while others may cover only part of the cost. Understanding this will help you anticipate any out-of-pocket expenses.

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Does my plan require prior authorization?

Prior authorization is a process your insurance plan may require to approve coverage for a prescribed product. Enteral nutrition often needs prior authorization to confirm that the product is medically necessary. This process is usually handled by your healthcare provider or home medical supplier. If prior authorization is required, remind your provider or supplier to complete this step to avoid delays in coverage.

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Do I need a Letter of Medical Necessity?

Many insurance plans require additional documentation beyond a prescription to approve coverage. This can include clinical notes and a Letter of Medical Necessity. Ask your insurance provider what documentation is needed so your healthcare team can prepare and submit it along with the prescription. To make this easier, we have created templates for Letters of Medical Necessity for each Kate Farms formula. You can share the appropriate template with your doctor to help streamline the process with your home medical supplier.

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