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Old 11-02-2010, 01:40 PM   #1
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Default tricare and pediasure

With a prescription is there a way to get it covered? Boost, anything like that?

My friend's son has cancer and can't keep food down with the chemo. Doctor wants him on high protein and liquids, basically boost and pediasure, he is too old for wic. Doc wrote a script and tricare said nope, not covering it.

Right now her hands are so full, she doesn't have a minute to fight them unless she knows she has a leg to stand on. Will they cover it? I'm trying to do what I can for her . They have prime.
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Old 11-02-2010, 01:52 PM   #2
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Default Re: tricare and pediasure

Let me check for you Jackie. Unfortunately, I think its a nay.
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Old 11-02-2010, 02:04 PM   #3
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Default Re: tricare and pediasure

Hey I found this:https://www.hnfs.net/common/benefits...exclusions.htm
Quote:
Food, Food Substitutes, Supplements, or Vitamins (outside a hospital setting) – Excluded, except when used as the primary source of nutrition for enteral, parenteral, or oral nutritional therapy. Intraperitoneal nutrition (IPN) therapy is covered for malnutrition as a result of end stage renal disease. A list of products that may be covered for nutritional therapy is available at http://www.dmepdac.com/dmecsapp/do/search. Nutritional therapy products are not covered solely to boost protein or caloric intake. (Costs)
It could possibly fall under oral nutritional therapy. Maybe her doc can help clarify.
Here's a DME (durable medical equipment website and Boost is on it) https://www.dmepdac.com/dmecsapp/do/...=&modelNumber=

If you an I'd give the DME company a call and see what they say as they should know the billing procedure for something like that and whether it would be covered.

I looked up "exclusions". You can do the same on any regions's website

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Old 11-02-2010, 02:21 PM   #4
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Default Re: tricare and pediasure

I found that and it's so confusing because it's covered but yet under exclusions "food supplements" is a no under any circumstance. I will have her look further into DME. Maybe it was just a no at the store?

Poor baby can't keep anything down and they absolutely cannot afford it at all .

Thanks for the info Stacey.
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Old 11-02-2010, 02:34 PM   #5
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Default Re: tricare and pediasure

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I found that and it's so confusing because it's covered but yet under exclusions "food supplements" is a no under any circumstance. I will have her look further into DME. Maybe it was just a no at the store?

Poor baby can't keep anything down and they absolutely cannot afford it at all .

Thanks for the info Stacey.
Oh man that breaks my heart Jackie.
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Old 11-02-2010, 02:37 PM   #6
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Default Re: tricare and pediasure

Mine too . We were stationed together years ago and I have known her since she was pregnant with him. I'm just trying to do what I can for her from where I am.
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Old 11-02-2010, 10:49 PM   #7
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Default Re: tricare and pediasure

Can you call the company that makes it and ask for samples?
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Old 11-03-2010, 06:47 AM   #8
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Default Re: tricare and pediasure

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Originally Posted by JessicaLee View Post
Can you call the company that makes it and ask for samples?
Boost won't do it, their program only helps those who are tube fed and can't afford the formula. I'm helping her work on pediasure to see what happens there. There is a program for financial hardship through Ross but it looks like it might be seniors only.

I've been googling like crazy and it seems from a few other military forums a few people have had it covered. But not for cancer. Their kids either were ftt or had cystic fibrosis. The weird thing is in those cases it is clearly only to boost calories, which tricare claims they don't cover.

This is so frustrating for her. If they wait until he's sick enough to need a tube feeding they will cover all those supplies, plus the surgery but it will cost tricare so much more than pediasure until he is off the chemo.

Sometimes it doesn't make any sense.
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Old 11-03-2010, 03:37 PM   #9
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Default Re: tricare and pediasure

oh man, that is so awful. that poor baby, just breaks my heart... there has to be something that can be done i am crossing my fingers and praying that they will come through and cover it..... i wish there was something i could do to help. what about a fundraiser for the little one? i know lots of parents who hold fundraisers for their lil ones in these situations.
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Old 11-04-2010, 01:01 AM   #10
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Default Re: tricare and pediasure

Jackie can you have her go speak with Patient advocacy? They may be able to facilitate this or at least be able to point her in the right direction.
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Old 11-04-2010, 07:05 AM   #11
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Default Re: tricare and pediasure

How awful! Is there anything we can do for them? I would be willing to send some commissary gift certificates if that would help?
I would honestly hope that TriCare would see this as a necessity.
I hope she can get some good news from them soon.
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Old 11-04-2010, 08:05 AM   #12
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Default Re: tricare and pediasure

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Jackie can you have her go speak with Patient advocacy? They may be able to facilitate this or at least be able to point her in the right direction.
I would if I was local. We aren't stationed together anymore. She's in OK. I would do it otherwise. That is one area I don't play around with, I've taken another friend by the hand and said listen lets go fight for your baby when the hospital was being stupid and she didn't know what to do.

EDIT I thought you said go with her, misread . I did suggest it to her, I don't know if she has tried yet.

I tend to be that person when it comes to the insurance company or the hospital being "no we can't do that" and I know they can. .

She makes bows and once she can get her website back up, she is going to be selling them to help him. She had to let the hosting lapse a little recently.

I'm guessing she either has to have the doc send a referral to express scripts or to DME to get it done. It's not something they are just going to cover with a script, it's listed as no pharmacy benefit when I look it up in the formulary directory.

I appreciate all the suggestions or help or even just trying to help. It means a lot to her to know people are trying and people care about her little guy.
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Old 11-04-2010, 08:16 AM   #13
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Default Re: tricare and pediasure

When she gets her website let me know and I'll help spread the word. I keep tearing up thinking about her little guy suffering. Please let me know if there is anything I can do.
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Old 11-04-2010, 08:41 AM   #14
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Default Re: tricare and pediasure

I will buy some bows when her site is back up. I'll also pass the word. Ya know, she can set something up on Facebook for free instead of doing a website that usually costs money. Plus, it's easier to advertise on FB because you can pass the word along.

There has got to be a way to get him those drinks. I mean, it seems like one of those things where you just have to figure out what the loophole in the system is. I hope she is able to get this all squared away soon.
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Old 11-04-2010, 08:54 AM   #15
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Default Re: tricare and pediasure

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Originally Posted by JessicaLee View Post
I will buy some bows when her site is back up. I'll also pass the word. Ya know, she can set something up on Facebook for free instead of doing a website that usually costs money. Plus, it's easier to advertise on FB because you can pass the word along.

There has got to be a way to get him those drinks. I mean, it seems like one of those things where you just have to figure out what the loophole in the system is. I hope she is able to get this all squared away soon.
I think she might try that, just has to find the time. she's up every 3 hours giving him meds all night, poor thing is so wiped out. I could hear it in her voice.

Once I get her email or facebook page or whatever I will post it if it's ok or pm members that asked about her bows.
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Old 11-04-2010, 09:45 AM   #16
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Default Re: tricare and pediasure

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Originally Posted by pilesoflaundry View Post
I think she might try that, just has to find the time. she's up every 3 hours giving him meds all night, poor thing is so wiped out. I could hear it in her voice.

Once I get her email or facebook page or whatever I will post it if it's ok or pm members that asked about her bows.
Yes, please PM me. I am really bad about checking threads on here.
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Old 11-04-2010, 11:41 AM   #17
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Default Re: tricare and pediasure

i ditto jessica and stace... once she gets her bows site up and running i will buy some and spread the word
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Old 11-04-2010, 11:55 AM   #18
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Default Re: tricare and pediasure

Thanks for everything girls .
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