Mother denied formula her baby needs to survive

[Boyz_Mum]

Looking up Elecare, I found the following link: http://elecare.com/obtain.aspx

And this is on the same page:
If You Cannot Afford EleCare

If your insurance does not cover EleCare and you cannot afford it, information on alternative government and private assistance programs you may qualify for can be found at The Partnership for Prescription Assistance Web site. There you’ll find more than 475 assistance programs, all on one site. Easy-to-answer questions show which programs apply to you. You will find downloadable applications, as well.
You can also call The Partnership toll free at 1-888-477-2669.

I didn't look at the partnership link because I have no idea if this family meets the requirements for help. I was happy to see that this formula company does have some policy/programs in tact to assist some people.

 

[lizzybeth]

Maybe you can include a picture of the little sweetheart in your email (I haven't sent mine but plan to today). It's easy to say no to a request when you can do it behind the comfort of your desk/computer. It's impersonal; you don't have to see who you are affecting. I dare anyone to say no looking at that precious face. I'm sure there are some that still could but hopefully it would make it more difficult.

 

[Boyz_Mum]

Maybe you can include a picture of the little sweetheart in your email (I haven't sent mine but plan to today). It's easy to say no to a request when you can do it behind the comfort of your desk/computer. It's impersonal; you don't have to see who you are affecting. I dare anyone to say no looking at that precious face. I'm sure there are some that still could but hopefully it would make it more difficult.

I couldn't say no after seeing him. He's so cute and cuddly looking! :blowkiss:

 

[Pxee]

If anyone knows how to contact the reporter or mom, Abbott has a patient assistance program which can be linked to through the Elecare web page. http://elecare.com/obtain.aspx The direct link to Partnership for Prescription Assistance https://www.pparx.org/Intro.php 1-888-477-2669. Yikes, fwiw, six 14 ounce cans cost $189.00. When mine was a little guy he would easily polish off 6-8 4 oz. bottles a day, this would have cost over $440.00 a week

That is for the concentrate... The Similac advance is only $40 a case less. It equals out to a less than $7 a can difference. That can be overcome. The family just needs to make adjustments.
The insurance company should comp the amount above normal formula... but where is the parental responsibility in this?? It is your child... you feed it. Whatever it takes you get your child what they need to survive. You don't allow your child to get frail and in a medical crisis because of money. If you can't handle it on your own... you call every church in your town, you call and write the makers of the formula, see if you can get some from the local hospital or pediatrician. You contact ANYONE who will listen to you to get some help. You don't sit back and allow your child to go down hill. This is America for cryin' out loud.
JMO

 

[southcitymom]

That is for the concentrate... The Similac advance is only $40 a case less. It equals out to a less than $7 a can difference. That can be overcome. The family just needs to make adjustments.
The insurance company should comp the amount above normal formula... but where is the parental responsibility in this?? It is your child... you feed it. Whatever it takes you get your child what they need to survive. You don't allow your child to get frail and in a medical crisis because of money. If you can't handle it on your own... you call every church in your town, you call and write the makers of the formula, see if you can get some from the local hospital or pediatrician. You contact ANYONE who will listen to you to get some help. You don't sit back and allow your child to go down hill. This is America for cryin' out loud.
JMO

No need to feel like an *advertiser censored*, Pxee. Welcome to Websleuths.

But still - the family pays for insurance to cover stuff like this and they surely seem to be doing everything they can to get this child the food he needs.

 

[LovingTheChaos]

One of my babies had to have Nutramagen, which at the time was double the cost of regular formula. My insurance didn't cover it, but my Pediatrician went out of her way to get us free samples & coupons. Enfamil sent me a case for free, along with 10 coupons for amounts between $5 - 10 off. In addition to that, any time I brought my kids to the Dr, they would load me up with samples from the company. I also was able to pay for the formula with my health now flex account.
I have never heard of health insurance covering infant formula.

 

[Texana]

One of my babies had to have Nutramagen, which at the time was double the cost of regular formula. My insurance didn't cover it, but my Pediatrician went out of her way to get us free samples & coupons. Enfamil sent me a case for free, along with 10 coupons for amounts between $5 - 10 off. In addition to that, any time I brought my kids to the Dr, they would load me up with samples from the company. I also was able to pay for the formula with my health now flex account.
I have never heard of health insurance covering infant formula.

I have to agree. I do understand in some instance the parents may need help because of income/health issues, however, it is not an automatic death sentence if the insurance doesn't pay for all of that.

I remember vividly when my older daughter was born, a neighbor had a premature baby. The child's specialized formula was covered under a state benefit for premature children. The parents were taking summer trips to Cozumel, Mexico for vacation and the mother talked about buying Stride Rite shoes for her child. All I could think was a) I'm not going to Cozumel b) my child is wearing Wal Mart and Pay Less shoes and c) my taxes are paying for your child's formula while you are going to Cozumel.

There should be means-testing on all formula and doctor prescriptions as well.

As heartless as it sounds, if the family is not truly poverty-stricken, they need to handle this on their own.

 

[RainbowsAndGumdrops]

If anyone knows how to contact the reporter or mom, Abbott has a patient assistance program which can be linked to through the Elecare web page. http://elecare.com/obtain.aspx The direct link to Partnership for Prescription Assistance https://www.pparx.org/Intro.php 1-888-477-2669. Yikes, fwiw, six 14 ounce cans cost $189.00. When mine was a little guy he would easily polish off 6-8 4 oz. bottles a day, this would have cost over $440.00 a week

I think you misread the quote. I looked it up and it looked like it was the powder that cost that much. The cheapest baby formula out there is about $1.50 per ounce. This formula comes out to $2.25 per ounce. It may cost her an extra $100 per month to "save her child's life". I understand the baby formula is expensive, but there are programs to help. This isn't more than a parent of twins would pay. In my opinion, if paying $100 extra per month for a year could save my child's life or improve their life that dramatically, I'd find a way to make it happen.

 

[RainbowsAndGumdrops]

[
But still - the family pays for insurance to cover stuff like this and they surely seem to be doing everything they can to get this child the food he needs.[/quote]

Insurance isn't usually designed for situations like this. Your insurance has specific things that they cover and do not cover. Insurance isn't an automatic no matter what happens in life they should take care of you. Just like life insurance, disability insurance, auto insurance, long term care insurance, etc there are rules established with what they cover. If you are in a car accident and the insurance doesn't replace the groceries that you were bringing home from the store, you can't blame them for that.You didn't have a policy to cover damaged goods in your car due to the impact or the delay getting them into the fridge. The same is true with elderly patients that need something like depends. They are very expensive, but they are not a medical necessity for the person to survive. I'd imagine most policies do not cover those either.

 

[yanknrebel]

Hubby and I adopted a set of preemie twins. They were 20 week preemies and were failure to thrive and very underweight when we got them at 5 months. They were on WIC and were prescribed Neosure (very expensive formula with alot of calories to put weight on them) and luckily WIC paid for it because the pediatrician wrote it as medically necessary. I do think they need to have the pediatrician write /prescribe the formula as medically necessary and then try to get on WIC.

 

[angelmom]

Insurance isn't usually designed for situations like this. Your insurance has specific things that they cover and do not cover. Insurance isn't an automatic no matter what happens in life they should take care of you. Just like life insurance, disability insurance, auto insurance, long term care insurance, etc there are rules established with what they cover. If you are in a car accident and the insurance doesn't replace the groceries that you were bringing home from the store, you can't blame them for that.You didn't have a policy to cover damaged goods in your car due to the impact or the delay getting them into the fridge. The same is true with elderly patients that need something like depends. They are very expensive, but they are not a medical necessity for the person to survive. I'd imagine most policies do not cover those either.

You would be right. The cost of Depends, latex gloves, wipes, etc. alone is astronomical and not covered at all. Not even a percentage, at least if they are on Medicare/Medicaid (I can't keep them straight) which most elderly patients are.

Hubby and I adopted a set of preemie twins. They were 20 week preemies and were failure to thrive and very underweight when we got them at 5 months. They were on WIC and were prescribed Neosure (very expensive formula with alot of calories to put weight on them) and luckily WIC paid for it because the pediatrician wrote it as medically necessary. I do think they need to have the pediatrician write /prescribe the formula as medically necessary and then try to get on WIC.

That's a good idea. I'm surprised their doctor or social worker hasn't helped them navigate these waters. (My friend who had an extreme preemie was assigned a social worker/patient advocate just for this type of thing.) WIC would determine if they qualify, and then help them until this situation is resolved. Hopefully when the child is old enough to eat table food they can find things that are safe. I guess it depends on the disorder.

Some people never think of this, but as you and your DH found out, feeding your baby is way more important than any psychological barrier one might have to asking for a "handout." I hope your twins are big, happy and healthy now!

 

[MissouriLady]

I agree that she needs to contact her pediatrician and WIC offices and see if there is anything that they can work out. I have a 3 month old that is in the early stages of liver failure. As a result, he has problems absorbing his fats normally and has been diagnosed with failure to thrive. Although he actually is on a feeding tube, our insurance doesn't cover his Pregestimil. However, WIC covers up to 8 cans per month as long as we have our note from the doctors.

If she makes too much to qualify for WIC, then she should be able to cope. Sure, she'll have to cut out some items that she typically buys but you gotta do what you gotta do. Hopefully she thoroughly checked out all of her options instead of automatically reporting her insurance company to the news before even receiving word back on her appeal.