Pathways to Reimbursement Success

Review your insurance plan to determine if the benefit is covered, and to what extent it is covered. Keep surprises to a minimum, know any coinsurance payments or deductibles that have not been met.

Ask whether you can obtain direct billing for metabolic products through your insurance provider. You may be able to authorize your insurance provider to pay for metabolic food products that are supplied to you. Direct billing can save you time, money and monthly paper work hassles, and it eliminates the inconvenience of having to pay for the foods upfront and then getting reimbursed by your insurance company.

If direct billing is not an option when ordering medical food (metabolic formula) or low protein food, request two copies of the original invoice from the company that provided the products. Ask the company to include a statement on the invoice explaining that the products are used for medical dietary treatment. Make sure the policyholder’s name, policy number and patient name is on the invoice. Send the invoice to the claims manager identified through your insurance plan. Check with the claims manager to see if other information would be helpful when submitting the claim (e.g., referral identifying supplier of medical food, etc...). Ask your insurance company whether it needs a letter of medical necessity and/or a prescription from your doctor or health-care provider that states why the medical foods or low protein foods are needed. Give the claims manager a courtesy heads-up call that the claim is coming. This contact person can likely help the process go more smoothly for you. Explain how important the products are to put a human face to the process and consider a personal thank you. People who care about customer service will appreciate it.

Be aware that self-insured plans (example: ERISA policies) are not mandated to reimburse for low protein foods or medical (metabolic) formulas.

Connect with the right person in your insurance company that follows special claims. Be sure to get their direct-dial line to avoid endless phone mail prompts. If we are unable to speak to a representative from your insurance plan within three attempts, we will contact you for a specific name and direct dial phone number in order to move your application through the approval process.

If using a Flexible Spending Account (FSA) debit card for co-payments, deductibles, or any other part of your order, you will need to have Ajinomoto Cambrooke established as an approved vendor. Please contact your account’s administrator to complete this process.