There is no requirement for private insurance to cover medical foods, including enteral formulas such as Physicians’ Elemental Diet™. Below are a few recommendations regarding insurance reimbursement.
Check your state laws & insurance company
Each state has different mandates around the coverage of enteral nutrition products. Depending on the state, they may require different documentation regarding diagnosis/reason for use. Always check the specific requirements for your state. However, because Physicians’ Elemental Diet is a medical food available without a prescription (but still through a practitioner), you may find yourself reactively appealing a claim vs proactively obtaining coverage. Contacting your health insurance company in advance will allow you to prepare the necessary documentation with your practitioner.
Appealing a Denied Claim
You may be able to appeal a denied claim. Start by having your healthcare practitioner provide a letter of medical necessity regarding your use of Physicians’ Elemental Diet.