Reimbursement Information
Some government and private insurance plans will consider covering EleCare for certain diagnoses. Each policy and plan will have their own coverage criteria and claims are reviewed case-by-case. Below is some general information about various programs. You can contact the Abbott Nutrition Reimbursement HelpLine with additional questions at (800) 558-7677.
WIC In most states, WIC (Women, Infants, and Children) Nutrition Programs will consider coverage for EleCare. And in most states, WIC is primary to Medicaid. Most programs consider EleCare to be a special formula or exception formula and require a physician's prescription that documents a medical reason for why the formula is needed. Contact your local WIC office to determine if EleCare can be covered.
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Medicaid Each state Medicaid program establishes its own guidelines for coverage of nutritional products in the outpatient or home-care setting. Many states will consider coverage of EleCare for children when it is tube fed or for oral use when specific medical necessity criteria is met. Coverage is determined on a case-by-case basis. Check with your Medicaid office or case manager for specific coverage information.
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Private Insurance Coverage policies and procedures for obtaining nutritional products vary across managed care plans, including Medicaid managed care plans. Many plans will consider coverage of EleCare for children when there's a need for a feeding tube or for oral use when specific medical necessity criteria is met. We encourage you to contact your provider directly by calling the phone number on your card for specific coverage information and directions. Requesting to speak with a nurse case manager is often helpful.
Patient Assistance Foundation If you can not afford EleCare and you do not have coverage through your insurance plan, the Abbott Nutrition Patient Assistance Foundation might be able to help. Visit The Partnership for Prescription Assistance website for downloadable applications. You can call The Partnership toll-free at (800) 222-6885 (Option 5).
State Laws Some states have enacted legislation that requires that reimbursement for certain types of medical foods be provided by certain insurance companies based on the patient's diagnosis. Click on your state to learn more about the legislation for amino-acid-based formula coverage.
For More Information Call the Abbott Nutrition HelpLine at (800) 558-7677.