DOWNLOAD THE LETTER OF MEDICAL NECESSITY
Some insurance plans may require a letter from your physician explaining why EleCare is necessary for your child.
Some government and private insurance plans will consider covering EleCare® or EleCare® Jr 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.
In most states, WIC (Women, Infants, and Children) Nutrition Programs will consider coverage for EleCare or EleCare Jr. And in most states, WIC is primary to Medicaid. Most programs consider EleCare and EleCare Jr 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 or EleCare Jr can be covered.
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 or EleCare Jr 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.
Some insurance plans provide coverage for medical foods. Individual plans have specific coverage guidelines and criteria that must be met. More often coverage exists in situations where there is medical necessity for a feeding tube, when medical foods are needed for inborn errors of metabolism, or when other specific medical criteria is met for an infant or a child. We encourage you to contact your insurance company directly for specific coverage and policy information.
Patient Assistance Foundation
If you cannot afford EleCare or EleCare Jr 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).
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.
- New Hampshire
- New Jersey
- New York
- Rhode Island
For More Information
Call the Abbott Nutrition HelpLine at (800) 558-7677.
*WIC is a registered trademark of the US Department of Agriculture and an abbreviation for the Special Supplemental Nutrition Program for Women, Infants, and Children. For eligibility guidelines, visit Food and Nutrition Services.