Insurance coverage for formula (1633)

Key points below

Your child’s insurance may or may not pay for their formula. This sheet has tips on how you might get help paying for your child’s formula.  

Who should I contact?

Your insurance company
Have your policy number when you call. Ask the insurance company if your child’s formula is covered. They may ask if the formula is given by mouth or by a feeding tube.
The formula company
Many formula companies can help you.  They might talk to your insurance company for you.  Go to their website or call them to ask if they can help.

What do I need to do if the formula is covered?

Ask for the exact steps you must take to get it paid for. They may need information from the doctor or the dietitian. Make sure you understand how you should buy the formula. You may have to:

What if the formula is not covered?

Ask the insurance company how to appeal the denial. A letter may be needed. Keep your receipts while you appeal. Some insurance companies may reimburse you for formula you bought during the appeal process.

What if I have to pay for the formula?

It may turn out that the insurance company does not cover formula. If formula is not covered, you may have to pay for it. This is called an out-of-pocket expense. 
These tips may help you save money.




Call your child’s doctor, nurse, or clinic if you have any questions or concerns or if your child has special health care needs that were not covered by this information.