Health Insurance covering regular formula??!! - Mothering Forums

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Old 09-20-2006, 01:02 PM - Thread Starter
 
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I was recently told Aetna will cover any & all formulas, no questions asked. I am beyond apalled. I hate to think even one cent that I pay for very expensive insurance helps offset the cost of formula for a mother who opted not to BF.
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Old 09-20-2006, 01:05 PM
 
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Wouldn't it be nice if they covered the cost of lactation consultants and nursing bras?

I agree. Formula is not medically necessary (except for certain situations).
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Old 09-20-2006, 01:27 PM
 
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I think insurance should cover formula when it is medically necessary, as long as medically necessary is broadly defined to cover emotional/psychological health. I would personally love to see formula be prescription only, but then heaven knows every doc and nurse would be writing a prescription for it.

That said, I think your information is wrong. I have Aetna and they wouldn't cover regular formula. Prescription, maybe, but that stuff is expensive and if a baby truly needs it because her mama can't or won't nurse her, I'm not going to begrudge her what she needs to grow up as healthy and strong as she can.

They do cover breastpumps though
http://www.aetna.com/cpb/data/CPBA0421.html

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Old 09-20-2006, 01:30 PM
 
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Ah, here you go:
Infant Formula

Quote:
Infant formulas are only covered if administered via the tube-feeding route and the criteria for coverage of enteral feedings are met. Infant formulas given orally are not covered.
http://www.aetna.com/cpb/data/CPBA0061.html

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Old 09-20-2006, 01:34 PM
 
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Look at that, they cover lactation consultants too!
Quote:
Breastfeeding Support and Education

Breastfeeding has benefits for both mothers and babies. According to the Centers for Disease Control and Prevention, breastfeeding lowers the risk of breast cancer and helps babies better fight off infection and diseases. This translates into fewer doctors' visits and less stress. In fact, the United States Breastfeeding Committee found $3.6 to $7 billion excess dollars are spent every year on conditions and diseases that are preventable by breastfeeding.

Aetna provides discounted breastfeeding support services to our members to encourage breastfeeding. Resources include educational materials, discounts on breastfeeding equipment and access to a Certified Lactation Consultant (CLC). The CLC works with women to initiate breastfeeding and help with a woman's transition back to work.
http://www.aetna.com/presscenter/kit...factSheet.html

And I know Blue Cross BLue Shield, at least here in PA, will pay for one year's LLL membership.

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Old 09-20-2006, 01:38 PM
 
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Quote:
Originally Posted by annettemarie View Post
Look at that, they cover lactation consultants too!

http://www.aetna.com/presscenter/kit...factSheet.html

And I know Blue Cross BLue Shield, at least here in PA, will pay for one year's LLL membership.

Thanks for info...now I have to check my insurance.
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Old 09-20-2006, 01:44 PM
 
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I have Aetna and they would *not* cover my pump. It depends on your employer (or spouse/partner's employer) and what coverages the employer selects. If DD had been a preemie, in NICU or had a reason she could not be put to breast, they would have covered my pump. But I would have had to get a PIS and I wanted the APY. Now I don't use my pump...go figure.

Also, I don't know that my plan covers LCs except for the LCs that visit in the hospital.

eta: I will say that I was impressed the other day while reading Aetna's site. They had something on there about preparing for twins and not a word about formula was mentioned. They said something like, "Rest assured you WILL make enough milk." Then, they gave tips on positioning to use for feeding.
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Old 09-20-2006, 01:50 PM
 
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That's a good point. I know we have limited benefits based on our employers' chosen plan.

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Old 09-20-2006, 02:45 PM - Thread Starter
 
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Another mother told me that based on her plan and drug pan any formula can be covered. This might not apply to all plans, but she is getting her formula for nothing but a copay.

Yes, there should be some coverage for prescription formulas, but apparently there are parents out there taking advantage of their insurance companies and getting assistance paying for regular formula that they chose to use.
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Old 09-20-2006, 02:52 PM
 
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Wow.

When Ina had to be supplemented and on formula (long story) -- it was Neocate (prescription only) and the alternative would have been hospitalization and IV or feeding tube administration --- the insurance co. would cover THAT but not the prescription-only, medically-necessary Neocate (and of course, did not cover pumps, LCs, etc. either, because I could always use formula : ).

I had never heard of regular formula being covered. I know in a few states, legislation has been passed to ensure that infants who are on elemental formula (like Neocate) will be covered by insurance, because families were paying $3-5,000 a month for formula and going, literally, bankrupt. But only a few states even have that mandate, I think. I never managed to get insurance coverage for formula.

Fortunately for us, I was bf and continued pumping to maintain my supply and return to bf - I had a good support system, including my OB and the Pediatrician, all of whom were very encouraging of me continuing to bf, going on the Elimination Diet etc. -- I think a lot of women lack that sort of information/support. I am *more* boggled by the moms who run into the hypo/elemental formula issue the first time 'round and don't even consider bf the next time. :

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Old 09-20-2006, 02:58 PM
 
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Quote:
Originally Posted by meganeilis View Post
Another mother told me that based on her plan and drug pan any formula can be covered. This might not apply to all plans, but she is getting her formula for nothing but a copay.

Yes, there should be some coverage for prescription formulas, but apparently there are parents out there taking advantage of their insurance companies and getting assistance paying for regular formula that they chose to use.
pak

this holds true for a lot of things and not just formula.

Kirsten - wife to Mark and co-sleeping, breastfeeding mother to , :, and
Photography, including Breastfeeding Photography, in my Homepage.
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Old 09-20-2006, 05:29 PM
 
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To be honest, I just wouldn't believe it without proof. I've seen absolutely nothing ever to indicate that insurance pays for regular infant formula for healthy babies.

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Old 09-20-2006, 05:32 PM
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Wowee, now I have to check to see if I can get free membership to LLL!
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