enterade may be eligible for reimbursement when prescribed by a healthcare provider for a medical need such as cancer treatment GI side effects.
It can be complicated to find out whether your insurance plan covers medical foods like enterade. In this blog, we outline the steps you can take to determine whether your insurance plan will reimburse you for enterade.
How do I know if my insurance plan covers enterade?
To check if enterade is covered by your insurance plan, follow the steps below:
- Call your insurance carrier- tell them you bought enterade AO (also known as enterade Advanced Oncology Formula) to manage the GI side effects of cancer treatment and that you'd like to know if it is covered by your plan.
- Provide the NDC code for the corresponding enterade flavor to your insurance carrier- NDC codes are used to identify medical products.
- Enterade® AO Vanilla
NDC Code 28028-0353-89
- Enterade® AO Orange
NDC Code 99422-0992-48
- Enterade® AO Mixed Berry
- Enterade® AO Watermelon
NDC Code 60008-0321-12
- Your insurance carrier will let you know if enterade is covered.
- If it is covered- Ask them what you will need to submit the claim i.e., prescription, clinical notes, and/or letter of medical necessity.
You will likely need to obtain a prescription from your physician or health care provider. The prescription will need to have:
- Your name (patients name)
- Date of birth
- Diagnosis: Your doctor should be familiar with the necessary reimbursement codes
- How enterade should be taken and if any refills are needed: Example: enterade 2x/day x 30 days plus 2 refills
If your insurance requires prior authorization, your doctor will have to submit the following.
- Clinic notes- this will be information related to Oncology or GI-related nutrition.
- Letter of Medical Necessity- your doctor will have to fill out a form that informs the insurance company that you need enterade. You can download this form here: Letter of Medical Necessity
Speaking with your insurance company can be a difficult process, so please do not hesitate to contact our customer service team. They will gladly walk you through the process and determine whether your insurance plan covers enterade AO.
