Formula4Success will not assist with researching coverage for FruitiVits unless an additional Vitaflo product is being researched for coverage. The below information should be used as a guide for patients, caregivers or healthcare professionals seeking coverage for FruitiVits independently.
Private Insurance Medical Policy
- Call the Member Services phone number located on the back of the insurance ID card
- Follow the prompts for Medical Benefits, and provide requested information for verification purposes
- Select to speak with a representative, and state that the call is for Medical Benefits
- Provide the Procedure Code B4104 (HCPCS Code)
- Provide the Diagnosis Code (ICD Code)
Private Insurance Pharmacy Policy
- Call the Pharmacy Services phone number located on the back of the insurance ID card
- Follow the prompts for Pharmacy Benefits, and provide requested information for verification purposes
- Select to speak with a representative, and state that the call is for Pharmacy Benefits
- Provide the Reimbursement Code 50600-0513-25 (Same format as NDC)
- Provide the Diagnosis Code (if necessary)
Oftentimes insurance representatives are unfamiliar with rare diseases, and they are unfamiliar with Vitaflo products. Although Vitaflo products are classified as a Medical Food, representatives may not be familiar with the term, or the insurance policy may not specifically state “Medical Foods”. Therefore, when communicating with insurance representatives, it may be helpful to use a few keywords, such as: medical food, medical formula, nutritional supplement, enteral formula, inborn error of metabolism (IEM) and inherited metabolic disease.
Provide Accurate Information.
Since it is highly likely that representatives will be unfamiliar with medical food coverage and benefit requests, it is extremely important to provide them with accurate codes to represent the disease and the product. HCPCS, ICD and Reimbursement Codes are golden bits of information that representatives can use to assist with benefit research and coverage verification. Once the codes are researched, it is possible that their system may classify the product as a supplement. Oftentimes supplements are not covered benefits; however, the policy may have an exclusion or inclusion which states coverage when “medically necessary” or for the treatment of specific metabolic disease or inborn errors of metabolism.
Understand the Policy.
Take detailed notes of the quoted coverage information. Representatives will typically offer coverage information for in-network benefits only. However, it is important to also take detailed notes for out-of-network benefits, if applicable. A few key things to make note of are: deductible, out of pocket maximum, co-pay, co-insurance, prior authorization, pre determination, PCP referral only, self-funded plan, fully funded plan, inclusions and exclusions. Also request to have a hardcopy of the insurance policy, and make sure to request a call reference number from the representative. The call reference number can be used as proof of the information provided.