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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 or a healthcare provider authorized to write prescriptions in your state. This may be a physician’s assistant, a nurse practitioner, or even a registered dietitian in some states. Here are some tips on how to navigate the conversation. 

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.

Are you familiar with Kate Farms?

If they aren’t yet familiar with Kate Farms, we have lots of resources to help them learn about our products. Direct them to the clinicians section of katefarms.com where they can review product offerings and suggested clinical use indications, get in touch with a sales person, or contact us to speak with one of our on-staff registered dietitians. Make sure to let your doctor know why you are interested in trying Kate Farms. Your nutrition preferences are important, and they’ll only know about them if you share! 
 
If they are familiar with Kate Farms, you’ve knocked out the first step – awesome! Reiterate why you are interested in Kate Farms. 

Which Kate Farms formula is right for me?

Your doctor will recommend the right formula based on your nutritional needs. If you require a special type of protein based on how your body responds to food, your doctor my suggest one of our peptide formulas, for example. If you need a lot of calories to support weight gain or maintenance, your doctor may recommend a formula with a higher caloric density.  

How much of my diet will come from formula? Do you consider it “medically necessary” for me?

This will be important for you to know as you embark on your formula journey, but also important for insurance coverage purposes. Most insurance companies will only cover formula if it’s deemed “medically necessary” by a doctor.  

If formula will be your sole-source of nutrition, meaning it will make up your entire diet because you cannot eat anything else, it will likely be covered by insurance (except for Medicare, which will not cover sole-source nutrition unless it’s through a feeding tube). If your doctor is recommending formula in addition to a partial solid food diet, find out if they consider it medically necessary, or simply a supplement suggestion. If it’s medically necessary, there is a better chance for insurance coverage. If not, your best option will be to purchase your formula online.  

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

This question will help set expectations for your medical nutrition journey including costs, insurance coverage, and usage. If you will be using formula for less than three months, insurance coverage is not likely, and we’d recommend purchasing online. If it will be long-term, coverage is much more likely, and it’s worth checking to see what formula benefits you have. You may start out without coverage options, but over time, qualify for coverage. It never hurts to check if your situation changes.  

If you are having difficult affording your formula, please contact us. We may be able to help. 

Ask for a prescription and supporting clinical documentation to be sent to a home medical supplier that can bill your insurance. 

For insurance to consider covering your formula, you will always need a prescription. The prescription has to be sent to a home medical supplier for insurance verification, and if you are eligible, the home medical supplier will bill your insurance and send your formula to your home. 

A prescription alone may be enough for insurance to cover our standard formulas, but not enough for them to cover our peptide formula. For that, the insurance company may require additional clinical notes and the home medical supplier will need to reach back out to the doctor’s office for the paperwork to continue verifying your benefits, which can delay the process. 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 to which you are entitled. 

If your doctor’s office isn’t clear on which home medical supplier would be the best fit for you, contact us. We can help guide you on where your prescription should be sent based on your insurance.

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.