Insurance Denials

BEYOND FORMULA

Getting Started With Real Food and Real Food Blends

Information on Insurance Denials

If you were informed by your Durable Medical Equipment (DME) supplier or home infusion provider that you do not have coverage for Real Food Blends or have been denied, it is important to understand why. In many cases, your insurance will cover our meals so:

It’s important to not take “NO” to mean “no way”!

If your DME/home infusion provider has told you they cannot provide Real Food Blends, please ask:

Why can they not provide?

  • Is this because my insurance has denied the claim? OR
  • Is this because this particular DME/home infusion provider isn’t familiar with the product / hasn’t stocked it before OR
  • Is this because the DME/home infusion provider is unwilling to provide due to reimbursement levels.

Insurance denial:

If your DME/home infusion provider informs you of a denial, it’s imperative that you ask for this denial in writing from your insurance company. Oftentimes if the insurance has denied, it is due to a lack of medical documentation to support coverage. (Formula intolerances – vomiting, nausea, reflux, motility issues, weight loss, etc. – can all all be medical reasons to to get approval for B4149 enteral nutrition products. These signs and symptoms of intolerance should be noted in your medical records.)

If lack of documentation is the reason, you can help your DME/home infusion provider rectify this by asking your doctor to supply the necessary documentation explaining why you are on the tube feeding and specifically why you need Real Food Blends versus a different formula or documented intolerances to other formulas you have tried.

Some insurance plans do not offer coverage for HCPCS code B4149. In this case, if you are currently receiving formula coverage for another formula, it can be worthwhile to contact your insurance company and ask for an exception due to medical necessity. There may be cost savings for your insurance company, depending on your formula, so it may be worthwhile to try to talk to them about making an exception.

DME/Home Infusion Refusing to Supply

If your DME/home infusion provider is unwilling to supply our meals, this could be due to a number of factors. First, it’s important to know if your insurance offers coverage for HCPCS code B4149 under your policy. (If it’s not a covered benefit, ask your insurer about exceptions to this due to medical necessity and what would be needed to show the need for the exception.)

If B4149 is a covered benefit, you can discuss with your DME/home infusion provider why they are unwilling to provide Real Food Blends. It may be more helpful to ask for a supervisor at this point.  It’s important to remember that you are the customer here, and usually can take your ‘business’ to another provider if they are unwilling to service (our list of providers is here).

If the DME/home infusion provider indicates that this is a business decision, please have them contact Real Food Blends to discuss the reimbursement and wholesale rates. Our meals are readily available direct at wholesale prices and also through all the major medical distributors – so any of these suppliers can get the meals and in the vast majority of cases, our meals are favorably reimbursed (meaning, we’re not asking DMEs/home infusion providers to lose money by providing our meals).

You can also discuss submitting for reimbursement directly with your insurance company. Although the insurance companies prefer to be billed through a DME supplier, this can be done. How this works is that you pay for the meals on our Web site and submit for reimbursement directly to your insurance company. We do have a discount code available for use in these situations. Please email us at info@realfoodblends.com for details.

As always, we are here to help! Please contact us at insurance@realfoodblends.com for insurance-related questions.