The insurance coverage picture for Real Food Blends is about as clear as mud these days! We are happy to report that more and more of you are having the meals covered by your insurance and provided directly from your DME (that’s a home health care company or Durable Medical Equipment company.) We wish this process was easier and we’re working to get coverage for as many tube-fed people as possible but these things take time. Here’s an update and answers to the most common questions about insurance coverage, and how you can secure coverage as well.
Why isn’t my DME willing to carry Real Food Blends?
First, they may just have not had anyone ask for it! This is a pretty simple problem to fix and usually the easiest way to have your insurer billed for the meals. Call your existing DME and tell them you would like them to verify your insurance coverage for HCPCS B4149. (Wholesale details are here.)
The second is a little more complicated but, like many things, boils down to money! Some state Medicaid programs don’t routinely cover formulas billed under this code. If the reimbursement rate isn’t published or if it’s really low, DMEs are unlikely to want to carry the meals as they need to be able to make some profit off providing the meals. If you are covered by another insurance or Medicaid is not your primary, it is still worth a call to your DME to ask for our meals / that they verify the insurance.
And finally, the last reason. Some of the larger DMEs have been unwilling to carry the meals despite customer demand for a variety of reasons (mostly, change is hard!) This tide is slowly changing, and the more vocal you all are about leaving a DME for one that will provide these meals, the more you are paving the way for those that come after you. One way you can help is to ask your RD to tell the sales reps from the big DMEs that they want the meals!
What can I do?
1 – Find a Local DME: Ask your medical team / dietitian for referrals to local DMEs. The smaller, local businesses have proven much more willing to go above and beyond for a customer, especially a new customer that has recurring medical needs. (If you are willing to switch your entire DME needs over to them, they are usually even more wiling to provide our meals as they make a much higher profit off the medical supplies than formulas typically. Make sure you tell your existing DME why you are leaving! (The list of current DMEs stocking our meals is here.)
2 – File for reimbursement. You can purchase the meals directly from us and use these steps to file for reimbursement from your insurer.
3 – Lobby your insurer. If you get a denial for our meals, either from your DME or for reimbursement, we can assist with the appeal process. Sometimes, under some plans, insurers will routinely deny any specialized formula on the first submission. During the appeal process, a real live human usually reads the reasoning for the special request and can use common sense to determine if the request should be approved.
4 – If your insurance is listed here, you can call Medline at 1-866-356-4997. They will verify your insurance coverage and ship out the meals directly to you.
What else to know?
Read through our insurance page to get more of an understanding about how insurance coverage / the reimbursement process works. And then get creative! We have some families using crowd funding to help pay for the meals (don’t be embarrassed, you’d be surprised how many people love having a tangible way to help!) Also, our monthly subscription program saves you 10% off the cost of the meals. Hope that helps clear up some confusion. Please reach out if you have any questions. We are here to help!