People with Medicare, family members, and caregivers should visit Medicare.gov, the official U.S. government site for people with Medicare, for the latest information on Medicare enrollment, benefits, and other helpful tools. Medicare Part B (medical insurance) covers enteral nutrition supplies under the prosthetic device benefit.
Be prepared: Ask your doctor for a prescription for your Functional Formularies product. Bring to your doctor’s visit: a sample referral form and letter of medical necessity.
Research: Find a DME that takes your insurance.
Make the call: Call your insurance company to ask what they need.
We are here to help! We have patient advocates available to help assist you in gaining insurance coverage for our products. Please contact us.
Proof of functional impairments; swallow study or speech therapy notes provided by your doctor. If above tests cannot be performed, detailed doctor’s notes need to be provided as to why.
Progress notes need to be current within six months and include: Proof that patient is 100% tube fed.
The length of feeding tube use. This needs to be stated numerically. (i.e. Number of the months/days, or 99 years to indicate lifetime use).
Proof of any trial and failure of commercial formulas. Notes need to state what formularies were tried, when, why patient did not tolerate, and if any medications or adjustments were made to combat the intolerance.
In order to receive Medicare coverage for Functional Formularies Liquid Hope, Nourish, Liquid Hope Peptide, Nourish Peptide, or Keto you may be asked for proven, documented intolerance to standard formulas. Notes may be required stating which standard formula was used, for how long, and what symptoms of intolerance were experienced, and how they were treated.
Demonstrated symptoms of intolerance may include one or more of the following: • Constipation • Diarrhea • Vomiting • Fatigue • Nausea • Decline in mental alertness • Bloating • Depression • Cramping • Weight loss