Who does that?

[phade]

So, I have a 7-week newborn. Baby has been crying a seemingly in pain for a few weeks. Repeated doctor visits have been productive and doc wanted to make sure the formula was the right fit. Last two weeks, the baby cried much morem (6-7 hours per day, 90+% when she is awake) and we've been to see the doc several times. Doc cleared her schedule and had us come in yesterday on short notice and luckily the baby went into a fit and gave the doc the signs she needed to address it.

She said the baby has harsh infant acid reflux AND the baby has an allergy/intolerance to animal proteins found in nearly all OTC formulas. Doc prescribed some med for the reflux and prescribed a very specific formula. Read...PRESCRIBED.

My medical/pharmacy plans are top-notch and I pay dearly for it. The med was approved and the formula was denied. At work here and tried calling in to appeal and not getting anywhere.

Maybe it's just me, but call me crazy if a doc prescribes something for a freaking newborn...that it should be approved. I understand the context of their business model, but wow is that low on the totem pole of life - denying a newborn prescribed formula.

I don't typically get fired up and ticked off, but if I could reach through that phone, I would...

So here we are, I have to go home and feed my baby a formula that I know is hurting her. Breaks my heart.

Edited March 8, 2013 by phade

[G-Man]

Sorry to hear that, but. More is coming under socialized healthcare its not gonna get any better... hope an alternative is found for you and your little one.

[WNYBuckHunter]

You can pick up soy based formula just about anywhere. Im assuming thats what they prescribed? If not, it may be a hypoallergenic type, which is pricey, but you should be able to find it. In any case, Id just talk to the Dr and see what other options there are. I remember a friend of ours had a baby that had the reflux problem, and they had to start mixing small amounts of the rice meal in the formula, which thickened it up a bit and helped.

Dealing with Insurance sucks though.

[Culvercreek hunt club]

we went throgh the ame thing. to this day when my daughter asks why she is an only child, we tell her becsue she was 18 mos old before she slept through the night. I don't know if you were able to try this but it is the only formula that my daughter could tolerate and it made a very big difference. Maybe your Dr has experience with it. It isn't cheap by any stretch.

http://www.enfamil.com/app/iwp/enf12/product.do?dm=enf&id=/Consumer_Home3/FeedingSolutions/NutramigenLGG&iwpst=B2C&ls=0&cm_mmc=Digitas-SEM-_-Google-Solutions-_-Nutramigen-_-nutramigen&csred=1&r=3540222422

I hope it turns around for you . Nothing worse that a crying child and at that age they just can't tell you what the issue is.

[phade]

You can pick up soy based formula just about anywhere. Im assuming thats what they prescribed? If not, it may be a hypoallergenic type, which is pricey, but you should be able to find it. In any case, Id just talk to the Dr and see what other options there are. I remember a friend of ours had a baby that had the reflux problem, and they had to start mixing small amounts of the rice meal in the formula, which thickened it up a bit and helped.

Dealing with Insurance sucks though.

Soy causes constipation and aggrivated her acid reflux. She was on it for two weeks, as well as Nutramagen, which is very "processed" animal protein formula. The Nutramagen is what works best OTC, but still causes the issues. This prescribed formula is one step beyond the Nutramagen as the doc described it.

Nutramagen is $26 a container and lasts 3-4 days.

Edited March 8, 2013 by phade

[Stretcher Guy]

See what happens when you have a job, pay taxes and have insurance!!!

Tell them you are in the country illegally and you will get everything you need for free.

[GreeneHunter]

See what happens when you have a job, pay taxes and have insurance!!!

Tell them you are in the country illegally and you will get everything you need for free.

Sad but True !!!

[WNYBuckHunter]

Soy causes constipation and aggrivated her acid reflux. She was on it for two weeks, as well as Nutramagen, which is very "processed" animal protein formula. The Nutramagen is what works best OTC, but still causes the issues. This prescribed formula is one step beyond the Nutramagen as the doc described it.

Nutramagen is $26 a container and lasts 3-4 days.

Gottcha. I know how pricey the hypoallegenic stuff is. Regular formula is bad enough. The days that I said the heck with baby food and switched my daughter and son over to regular food were great. The only better one for the wallet is when you stop with the diapers lol.

Hopefully its something she gets past sooner rather than later.

[Culvercreek hunt club]

Sorry to hear it. Mind if I ask who the insurance carrier is?

[josephmrtn]

So, I have a 7-week newborn. Baby has been crying a seemingly in pain for a few weeks. Repeated doctor visits have been productive and doc wanted to make sure the formula was the right fit. Last two weeks, the baby cried much morem (6-7 hours per day, 90+% when she is awake) and we've been to see the doc several times. Doc cleared her schedule and had us come in yesterday on short notice and luckily the baby went into a fit and gave the doc the signs she needed to address it.

She said the baby has harsh infant acid reflux AND the baby has an allergy/intolerance to animal proteins found in nearly all OTC formulas. Doc prescribed some med for the reflux and prescribed a very specific formula. Read...PRESCRIBED.

My medical/pharmacy plans are top-notch and I pay dearly for it. The med was approved and the formula was denied. At work here and tried calling in to appeal and not getting anywhere.

Maybe it's just me, but call me crazy if a doc prescribes something for a freaking newborn...that it should be approved. I understand the context of their business model, but wow is that low on the totem pole of life - denying a newborn prescribed formula.

I don't typically get fired up and ticked off, but if I could reach through that phone, I would...

So here we are, I have to go home and feed my baby a formula that I know is hurting her. Breaks my heart.

I know what my mom would say!!! Nurse the kid!!! (my mom works w some amish and mennonites a bit) Babys stomachs aren't meant to digest formula or dairy products they are meant for breastmilk....

[phade]

Sorry to hear it. Mind if I ask who the insurance carrier is?

BCBS and Express Scripts

[phade]

I know what my mom would say!!! Nurse the kid!!! (my mom works w some amish and mennonites a bit) Babys stomachs aren't meant to digest formula or dairy products they are meant for breastmilk....

Not possible in this situation; although it is our genetic child, my better half was not pregnant. Her sister was a gestational carrier.

Tough titty said the kitty when the milk ran dry.

[pewlodar]

I had issues MVP before. Doctor prescribe 10 mg pill twice a day, MVP would only approve 20 mg once a day which wasn't as affective. How much senses does that make. Hate dealing with insurance companies.

Best of luck getting with the formula. After spending 2 days with my twins regurgitating anything they drank, there is nothing worse then your child cries and you can help them.

[josephmrtn]

Not possible in this situation; although it is our genetic child, my better half was not pregnant. Her sister was a gestational carrier.

Tough titty said the kitty when the milk ran dry.

that sucks....

[Cabin Fever]

How much is the prescribed formula, if you pay out of pocket, at least until you can fight the insurance company? I would call all the local pharmacies and get their price. I understand that each pharmacys prices can vary greatly. I'm sure it'll sting ($), but it'll be worth it if it helps the baby.

Hopefully your daughter will grow out of the allergies. When my daughter was little, she had an allergy to all milk products, pork, and beef. It was hell to deal with! Thank God for venison and chicken!! She eventually grew out of it.

[Early]

My newest grandson is on Newtramagen and doing extremely well. He is the happiest baby we have ever seen...never any colic at all. We search carefully for coupons to help offset the cost...still expensive, but obviously worth it.!

Just for the hell of it, check out the ADVOCATE column in the Albany, NY Times Union newspaper. (timesunion.com) Maybe there is someone like that in your area that could help you. Even insurance companies dislike bad publicity.

Good Luck,

Early

[ELMER J. FUDD]

I would at least try carnation good start. A few reviews i came across sound similar to yours.

[tuckersdaddy]

contact the formula maker. alott of times they have decent coupons to help off set cost. plus if its prescribed, save the receipts you will be able to claim it on your taxes for uncovered medical expenses. (unless obama care fixes that to)

[tuckersdaddy]

contact the formula maker. alott of times they have decent coupons to help off set cost. plus if its prescribed, save the receipts you will be able to claim it on your taxes for uncovered medical expenses. (unless obama care fixes that to)

[tughillhunter]

My newest grandson is on Newtramagen and doing extremely well. He is the happiest baby we have ever seen...never any colic at all. We search carefully for coupons to help offset the cost...still expensive, but obviously worth it.!

Just for the hell of it, check out the ADVOCATE column in the Albany, NY Times Union newspaper. (timesunion.com) Maybe there is someone like that in your area that could help you. Even insurance companies dislike bad publicity.

Good Luck,

Early

Very true.

[Geno C]

sorry to hear that phade, that has to raise the ole level of stress and im sure its not an easy feeling seeing your baby in an uneasy state.

[phade]

Thanks for all of the kind words.

Didn't make much sense that they would deny it, but they did initially, even after I called and appealed. I work for a large company and I am lucky to have access to senior leadership. Was chatting with my boss (a Director) and she made a call to our VP of HR at 4:15. 15 minutes later...got a call from Express Scripts. They apologized and stated that it should indeed be covered under the plan - and that it shouldn't have been denied in the first place. Going to get the prescription and the new formula first thing tomorrow from the doc's office and the pharmacy.

[josephmrtn]

Great!!!

[Lawdwaz]

Thanks for all of the kind words.

Didn't make much sense that they would deny it, but they did initially, even after I called and appealed. I work for a large company and I am lucky to have access to senior leadership. Was chatting with my boss (a Director) and she made a call to our VP of HR at 4:15. 15 minutes later...got a call from Express Scripts. They apologized and stated that it should indeed be covered under the plan - and that it shouldn't have been denied in the first place. Going to get the prescription and the new formula first thing tomorrow from the doc's office and the pharmacy.

That is certainly great news!!

Please keep us posted on how she is doing.

[tuckersdaddy]

Thanks for all of the kind words.

Didn't make much sense that they would deny it, but they did initially, even after I called and appealed. I work for a large company and I am lucky to have access to senior leadership. Was chatting with my boss (a Director) and she made a call to our VP of HR at 4:15. 15 minutes later...got a call from Express Scripts. They apologized and stated that it should indeed be covered under the plan - and that it shouldn't have been denied in the first place. Going to get the prescription and the new formula first thing tomorrow from the doc's office and the pharmacy.

lets hope everyone gets some sleep this weekend!