Health Products Covered by Insurance
At one point Matthew was malnourished and severely anemic. This prompted a Prescription for Ensure Plus to help gain weight. I first researched and compared Ensure to PediaSure for the calories they each contained and flavors available.
I compared the calories in Pediasure and Ensure at the store and then I purchased a few six packs until I found one my son would tolerate. They have a large variety of these drinks with flavors and vitamins. Then I checked the website and printed data for the Pediatrician. I called the pharmacy and spoke with the representative to find out how the Esure would be sold. The store contains 6 cans in a pack, but with insurance they come 24 in a case, an important note when requesting a prescription for a specific number of cases. I went with one case a week, which was the equivalent of two cans a day. Depending on the insurance and pharmacy you may get a three-month supply like I did.
The same method had been applied when determining the diapers Matthew would get and how many each month. Years ago in California the Regional Center would pay for Diapers and now they have it on a reimbursement plan for families with children between the ages of 3 and 5 who are not toilet trained due to their disability.
The Regional Center informed me when Matthew turned five that we had to go through his Insurance Plan for the diaper supply. I first contacted the pharmacy located at the medical group and inquired as to what brands they covered and what was available through my son's Insurance Plan.
If you want a name brand diaper that is not a generic youth diaper that will bother a sensory kid, you first need to make sure what your Insurance plan covers. I found out that the regular Medi-Cal for the State of California, known as straight Medi-Cal and not an HMO will only cover generic brands. This is why I kept Matthew with CareFirst Health Plan.
We actually started with regular Huggies size 5 and then 6 before moving onto the Goodnites underpants. As the sizes go up there are less diapers and underpants in each package, so your prescription might need to be adjusted. For example when Matthew was wearing the size S/M for Goodnites we received four cases per month and when he passed 60 pounds we moved onto the L/XL with an upgrade to five cases per month.
All the approvals and upgrades are done through the Pharmacy office. The initial prescription is received from the Pediatrician if a child or other type of Doctor if you are needing depends or other garment aids for elder care. The Pediatrician wrote down the number of cases per month and that my son has severe autism with incontinence and the number of refills, usually like 6 or 12 to cover six months to a full year.
When Matthew developed PICA from drinking the Ensure Plus I located a Soy supplemental drink at Sav-on that Matthew liked and then I called the company to find out how they distribute and gave that data to the Pharmacy clerk I deal with. It turns out the Pharmacy had to set up an account with the company and they would only deliver a six month supply, which the Pharmacy had no room for so a truck delivered straight to my house from their warehouse. I had cabinets filled with this drink.
When they were preparing at the Elementary school for earthquakes and wanting families to stock a bag of supplies for each child I brought a case of Ensure Plus for them to have on hand. I had a few cases left over when we switched over to a Soy drink and sold them easily on ebay and used UPS to ship them out.
If you have a family member with a disability who needs a health product look into getting a Prescription for it and have it covered on the Insurance Plan. The same thing can be done for elder care with parents that have Alzheimer's or other issues and need a supplemental drink or might need incontinence products.
Shop around for a pharmacy that delivers, if possible or go directly through the company and get reimbursed or at the very least deduct it on your income taxes. Hospitals have pharmacies also and might be able to work with you while a family member is already in the Hospital before being released.
If the person is fed through a tube the supplies can be covered through an Insurance Plan also. You might have to shop around for a different Prescription Plan to get the name brand covered.
Educational Autism Tips for Families 71 page resourceful ebook for families entering the school system with a recent autism diagnosis. Find out what issues take place over the course of a school day and meet these challenges head on.
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