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Insurance coverage of medical foods for treatment of inherited metabolic disorders.

Berry SA, Kenney MK, Harris KB, Singh RH, Cameron CA, Kraszewski JN, Levy-Fisch J, Shuger JF, Greene CL, Lloyd-Puryear MA, Boyle CA - Genet. Med. (2013)

Bottom Line: Treatment of inherited metabolic disorders is accomplished by use of specialized diets employing medical foods and medically necessary supplements.Families seeking insurance coverage for these products express concern that coverage is often limited; the extent of this challenge is not well defined.Although nearly all children with inherited metabolic disorders had medical coverage of some type, families paid "out of pocket" for all types of products.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA.

ABSTRACT

Purpose: Treatment of inherited metabolic disorders is accomplished by use of specialized diets employing medical foods and medically necessary supplements. Families seeking insurance coverage for these products express concern that coverage is often limited; the extent of this challenge is not well defined.

Methods: To learn about limitations in insurance coverage, parents of 305 children with inherited metabolic disorders completed a paper survey providing information about their use of medical foods, modified low-protein foods, prescribed dietary supplements, and medical feeding equipment and supplies for treatment of their child's disorder as well as details about payment sources for these products.

Results: Although nearly all children with inherited metabolic disorders had medical coverage of some type, families paid "out of pocket" for all types of products. Uncovered spending was reported for 11% of families purchasing medical foods, 26% purchasing supplements, 33% of those needing medical feeding supplies, and 59% of families requiring modified low-protein foods. Forty-two percent of families using modified low-protein foods and 21% of families using medical foods reported additional treatment-related expenses of $100 or more per month for these products.

Conclusion: Costs of medical foods used to treat inherited metabolic disorders are not completely covered by insurance or other resources.

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Related in: MedlinePlus

Percentage of reported payment sources used for medical foods and related productsPercentage of payment sources used for medical foods, dietary supplements, modified low-protein foods, and feeding supplies is noted on the y axis. Families used more than one payment source for some products and often paid for multiple products. Other, military health benefits and miscellaneous other sources; Self, parents' out-of-pocket expenditures; WIC, Women, Infant, and Children programs.
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Figure 1: Percentage of reported payment sources used for medical foods and related productsPercentage of payment sources used for medical foods, dietary supplements, modified low-protein foods, and feeding supplies is noted on the y axis. Families used more than one payment source for some products and often paid for multiple products. Other, military health benefits and miscellaneous other sources; Self, parents' out-of-pocket expenditures; WIC, Women, Infant, and Children programs.

Mentions: Families relied on multiple payment sources for individual products and/or may have used multiple payment sources for multiple product types. Figure 1 shows all reported payment sources by product type. χ2 Test results indicated that across the product types, there were significant differences in the distribution of reported payment sources used to purchase the different types of products (χ2 = (12, N = 753) 159.53, P < 0.005). Medicaid often covered medical foods, dietary supplements, and feeding (40, 35, and 31% of reported sources, respectively). Private insurance also frequently contributed to the coverage of medical foods (30%) and dietary supplements (32%).


Insurance coverage of medical foods for treatment of inherited metabolic disorders.

Berry SA, Kenney MK, Harris KB, Singh RH, Cameron CA, Kraszewski JN, Levy-Fisch J, Shuger JF, Greene CL, Lloyd-Puryear MA, Boyle CA - Genet. Med. (2013)

Percentage of reported payment sources used for medical foods and related productsPercentage of payment sources used for medical foods, dietary supplements, modified low-protein foods, and feeding supplies is noted on the y axis. Families used more than one payment source for some products and often paid for multiple products. Other, military health benefits and miscellaneous other sources; Self, parents' out-of-pocket expenditures; WIC, Women, Infant, and Children programs.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4541808&req=5

Figure 1: Percentage of reported payment sources used for medical foods and related productsPercentage of payment sources used for medical foods, dietary supplements, modified low-protein foods, and feeding supplies is noted on the y axis. Families used more than one payment source for some products and often paid for multiple products. Other, military health benefits and miscellaneous other sources; Self, parents' out-of-pocket expenditures; WIC, Women, Infant, and Children programs.
Mentions: Families relied on multiple payment sources for individual products and/or may have used multiple payment sources for multiple product types. Figure 1 shows all reported payment sources by product type. χ2 Test results indicated that across the product types, there were significant differences in the distribution of reported payment sources used to purchase the different types of products (χ2 = (12, N = 753) 159.53, P < 0.005). Medicaid often covered medical foods, dietary supplements, and feeding (40, 35, and 31% of reported sources, respectively). Private insurance also frequently contributed to the coverage of medical foods (30%) and dietary supplements (32%).

Bottom Line: Treatment of inherited metabolic disorders is accomplished by use of specialized diets employing medical foods and medically necessary supplements.Families seeking insurance coverage for these products express concern that coverage is often limited; the extent of this challenge is not well defined.Although nearly all children with inherited metabolic disorders had medical coverage of some type, families paid "out of pocket" for all types of products.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA.

ABSTRACT

Purpose: Treatment of inherited metabolic disorders is accomplished by use of specialized diets employing medical foods and medically necessary supplements. Families seeking insurance coverage for these products express concern that coverage is often limited; the extent of this challenge is not well defined.

Methods: To learn about limitations in insurance coverage, parents of 305 children with inherited metabolic disorders completed a paper survey providing information about their use of medical foods, modified low-protein foods, prescribed dietary supplements, and medical feeding equipment and supplies for treatment of their child's disorder as well as details about payment sources for these products.

Results: Although nearly all children with inherited metabolic disorders had medical coverage of some type, families paid "out of pocket" for all types of products. Uncovered spending was reported for 11% of families purchasing medical foods, 26% purchasing supplements, 33% of those needing medical feeding supplies, and 59% of families requiring modified low-protein foods. Forty-two percent of families using modified low-protein foods and 21% of families using medical foods reported additional treatment-related expenses of $100 or more per month for these products.

Conclusion: Costs of medical foods used to treat inherited metabolic disorders are not completely covered by insurance or other resources.

Show MeSH
Related in: MedlinePlus