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Talk to Your Doctor

If you are interested in insurance coverage for Kate Farms, you must have a prescription from your doctor. Here are some tips on how to navigate that conversation.

If your doctor isn’t yet familiar with Kate Farms, bring them a copy of our Get Started packet or suggest they visit the For Clinicans section of our website to review product offerings and suggested clinical use indications. If they have questions or would like to speak with one of our on-staff Clinical Nutrition Managers, have them contact us.

If your doctor is familiar with Kate Farms, work together to determine which formula would be best for you. The resources listed above may be helpful.

What to do after you’ve decided on a formula

Once you and your doctor have agreed on which Kate Farms formula is right for you, ask them to fax a prescription for that formula to your current home medical supplier. They may find this prescription form template helpful. If you need help finding a home medical supplier that carries Kate Farms, you may contact us for assistance.

Questions to ask your doctor that may impact insurance coverage:

Here are some questions to ask your doctor prior to starting a formula that may factor into whether or not your insurance company will cover formula for you.

What Kate Farms formula is right for me?

Why this is important: Your doctor will recommend the right formula based on your nutritional needs. Detailed product information that a healthcare professional will want to know can be found in the for For Clinicians section of our website. If you require a special type of protein, your doctor my suggest one of our peptide formulas, for example. If you need a lot of calories to support weight gain, your doctor may recommend a formula with a higher caloric density. Each type of Kate Farms product has an associated insurance code that, depending on your provider, will require a different level of medical documentation as to why you need it. You will always need a prescription form, at minimum. A prescription form alone may be enough for insurance to cover our standard formulas, but not enough for them to cover a peptide formula. For that, they may require additional clinical notes and the home medical supply company may need to reach back out to the doctor’s office for this paperwork before insurance will approve your request. Knowing ahead of time which product your doctor will be requesting and asking them to include all related medical necessity documentation when sending over the prescription will be helpful in ensuring you receive coverage you for which you are entitled.

Note: Even if you are not interested insurance coverage, if you will be using formula for a medical need, we recommend checking with your healthcare provider that oversees your nutrition plan for their suggestion on which product would best fit your needs.

What percent of my calories will need to come from formula?

Why this is important: “Sole-source” means that formula will be your only source of nutrition. Many insurance companies cover formula when it’s necessary for sole-source nutrition. Sometimes supplemental nutrition is recommended by a doctor, but is not deemed “medically necessary,” meaning it is not required to maintain your current body mass index or weight, for example. Usually, insurance will only cover nutrition that is considered a medical necessity by your doctor.

What percent of my calories will need to come from formula?

Why this is important: Kate Farms is appropriate for both sole-source and supplemental nutrition. That means you can use Kate Farms for 100% of your nutrition, or as a portion of your diet. Insurance companies often require that at least half of your total calories in a day come from formula to be eligible for insurance coverage. There are exceptions, but these need to be documented and clinically justified in your medical record. Ultimately, it will depend on your policy, and your insurance company determines what they will cover.

How long will I need formula? Will this be temporary or long-term?

Why this is important: Knowing the length of time you will need formula, if it’s temporary or long term, will help determine insurance coverage or if it even makes sense to look into coverage. It’s not uncommon for insurance companies to take 2 to 4 weeks to authorize coverage. If you need formula for less than this period of time, purchasing from shop.katefarms.com may be a better option.

Contact a Patient Advocate

Free, personal support to help you talk to your doctor, home medical supplier, or insurance provider, or for more information on getting started with Kate Farms.