Thursday, March 1, 2012


Today we got the BEST news from our insurance company! Cooper's formula will be covered at 100%. This is such a big deal for us because he is on Similac Alimentum's Ready to Feed. Why do you ask is he on this...

When Cooper was born, my goal was to exclusively breastfeed. The first two days, we had serious latch issues. So, I bought nipple shields (two different awesome good time...not frustrating at all). This was working; however, he was extremely sleepy due to jaundice and it was not improving and he was losing a lot of weight, so the pediatrician had us supplement. Then King Coop did not want to go back to the breast....more awesomeness. I began pumping like crazy (every 2-3 hours) except I was only able to get 1.5-2.5 ounces from each side each time. I began taking Fenugreek which is one of the most disgusting things you can take. I took 3 pills 3 times a day and I got a prescription to increase my supply. While all this was going on, Cooper had HORRIBLE tummy issues. We had to keep switching the supplemental formula to find what worked best. I was told I should probably go dairy free. If I went dairy free, I would have to pump and dump for a month for all the dairy to be out of my system in order to give him my breast milk.

I was heartbroken to give up breastfeeding, but it was all just too much. We switched him to Similac Alimentum powder formula exclusively and yet, I still had a boy who cried and was irritable all the time. Then I read I should try the Ready to Feed and it worked. Praise God! The lowest cost we found for Ready to Feed was $9.17 per 32oz at Walmart. Our current average is 32oz per day. Cost per week $59.19 (with a coupon) plus tax per week. And, you know babies...they just keep upping their demand...little buggers!

About a month ago, I thought that it would be worth a shot to try to get the insurance to cover his formula. I thought my case was pretty good...low milk supply and cow's milk protein sensitivity or allergy. We had to get a predetermination which meant the doctors office had to submit a bunch of paperwork. Funny thing...the office didn't even know the codes to submit because they had never had anyone try to get it covered through the insurance. I googled and googled. Here are the codes you need to get the insurance to cover it...The HCPCS code for Similac Alimentum is B4161 and the NDC-format codes are
70074-0576-64 for 16-oz Powder, 70074-0575-09 for 8-fl-oz Ready To Feed and 70074-
0575-13 for 32-fl-oz Ready To Feed.

I'm sure that many insurance plans would still deny it; however it is always worth a shot!

1 comment:

  1. Glad I came across your blog. Just left the Dr's. office and she was happy to write a script for her Similac Alimentum. She didn't even know you could do that. So should I go ahead and email her info of those codes just incase? My baby will only drink the rtd. What insuracne do you have? We have Aetna. So what do I do with this script just take it to a pharmacy??