Some insurance plans may require a letter from your physician explaining why EleCare is necessary for your child. To obtain a letter of medical necessity for your doctor to complete, contact Abbott Nutrition’s PATHWAY Reimbursement Support Program at 1-800-558-7677.
Navigating through the insurance coverage process can be difficult and complex. Coverage of nutritional products varies depending on many things, including the type of insurance plan, the coverage policy, the care setting, the patient’s diagnosis, and the route of administration (oral or tube fed). Out-of-pocket costs such as deductibles, co-pays, and co-insurance also vary depending on the insurance plan. To help you better understand your insurance coverage and payment options, contact Abbott Nutrition’s PATHWAY Reimbursement Support Program at 1-800-558-7677 (Monday through Friday from 8:30 AM to 5:00 PM, EST) and speak with a PATHWAY reimbursement counselor. You can also visit PATHWAY for additional information.
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 criteria regarding coverage of nutritional products. Medicaid programs may cover nutritional products when fed through a feeding tube, and many states will cover products consumed orally (swallowing) when specific criteria are met. All state Medicaid programs’ coverage policies vary whether you are covered under Medicaid or a Medicaid managed care plan. To learn more about your Medicaid coverage policy, call Abbott Nutrition’s PATHWAY Reimbursement Support program at 1-800-558-7677 (Monday - Friday, 8:30am-5:00pm EST).
Insurance coverage varies by plan. Some insurance plans cover nutritional products when the patient’s health condition meets specific criteria. The healthcare provider must provide information supporting the diagnosis, condition, and medical necessity to justify the need for the product. Additionally, some states have insurance mandates that require certain payers to cover medical foods for certain conditions. These state mandates are all very different. To learn if your insurance plan covers nutritional products, call Abbott Nutrition’s PATHWAY Reimbursement Support program at 1-800-558-7677 (Monday - Friday, 8:30am-5:00pm EST).
To learn if your insurance plan covers nutritional products, call Abbott Nutrition’s PATHWAY Reimbursement Support program at 1-800-558-7677 (Monday - Friday, 8:30am-5:00pm EST).
Patient Assistance Program
Abbott Nutrition believes that access to products recommended by healthcare providers is important for all patients. If you do not have access to alternative sources of coverage or funding of Abbott Nutrition products, you may qualify for Abbott Nutrition’s Patient Assistance Program. This program is designed to provide supplemental product at no cost to eligible patients experiencing financial difficulties. For additional information about Abbott Nutrition’s Patient Assistance Program, visit PATHWAY or call 1-866-801-5657 to speak with a representative.
Each healthcare provider is ultimately responsible for verifying codes, coverage, and payment policies used to ensure that they are accurate for the services and items provided. Providers should consult with the insurance plan for complete and accurate details concerning documentation for claims. Abbott Nutrition does not guarantee reimbursement by any third-party insurance plan and will not reimburse physicians or providers for claims denied by third-party insurance plans.
*Among those recommending amino acid-based products for infants and children ages 1 and up.
†WIC is a trademark of the US Department of Agriculture and an abbreviation of the Special Supplemental Nutrition Program for Women, Infants, and Children. No endorsement of any brand or product by the USDA is implied or intended.