Learn about insurance coverage for Kate Farms
Kate Farms medical nutrition* is broadly eligible for insurance coverage through major public and private insurance plans. Exact coverage depends on whether you or your loved one will be using the product for tube feeding or drinking, the diagnosis on the prescription, how many calories will come from formula each day, and the insurance plan’s formula benefits.**
Exploring insurance coverage can seem daunting, and we want to make it as easy as possible. Read on for information about coverage for select major insurance types, how to check your coverage, and what to do about denials. Contact us anytime with any questions. We’re here to help!
*Kate Farms Nutrition Shake is not eligible for insurance coverage.
**As the manufacturer, Kate Farms cannot bill insurance directly.
We have helped thousands of patients through the process of checking insurance coverage and have learned the following about formula coverage for the insurances listed below.
If you’d like to find out if you are covered for Kate Farms before asking your doctor to write a prescription, call the member services phone number listed on the back of your insurance card.
When you call, tell the representative how you will use Kate Farms, either for tube feeding or drinking, and provide the billable insurance code, also known as the HCPCS code, for the Kate Farms formula you’re considering.
Here are a few questions to ask to help you understand your coverage. Note: insurance companies will refer to formula by the term enteral nutrition, meaning nutrition that goes through the GI tract and is taken by mouth or feeding tube. This will help them differentiate from a benefit you may have for total parenteral nutrition, which is the term for nutrition that bypasses the GI tract completely and is administered by an IV. We recommend using the term enteral nutrition to help keep you and the representative on the same page.
There are a number of reasons why you might receive a denial for insurance coverage, but many of those reasons could be corrected with an additional clinical note from your doctor or clarification on your paperwork. Let us help navigate your denial and see if it is truly a “no.” We recommend working closely with your healthcare and home medical providers to learn if there is an opportunity to appeal the decision.
Our Patient Advocacy team provides free, personal support.
Contact us for more information on getting started with Kate Farms, or with questions about talking to your healthcare provider, home medical supplier, or insurance provider.
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