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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

Cost per month paid OOP for medical foods and related productsPercentage of families reporting OOP expenditures for medical foods, dietary supplements, modified low-protein foods, and feeding supplies is noted on the y axis. Families often paid for more than one product type. Families reported the range of costs they paid per month beyond insurance or other coverage for medical foods, modified low-protein foods, supplements, and supplies. Shown here are the ranges of OOP expenditures for each type of product (on the x axis); OOP, out of pocket.
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Figure 2: Cost per month paid OOP for medical foods and related productsPercentage of families reporting OOP expenditures for medical foods, dietary supplements, modified low-protein foods, and feeding supplies is noted on the y axis. Families often paid for more than one product type. Families reported the range of costs they paid per month beyond insurance or other coverage for medical foods, modified low-protein foods, supplements, and supplies. Shown here are the ranges of OOP expenditures for each type of product (on the x axis); OOP, out of pocket.

Mentions: Figure 2 shows the percentage of parents reporting OOP expenditures by product type. χ2 Test results indicated that across product types there were statistically significant differences in the distribution of OOP expenditure levels for the different types of products (χ2 (9, N = 632) = 141.27, P < 0.005). A total of 21% of parents purchasing medical foods paid more than $100 per month (beyond the costs for an unaffected child), as did 48% of parents purchasing modified low-protein foods, 11% purchasing dietary supplements, and 6% requiring feeding supplies. Some families reported paying $500 or more for medical foods (4%), modified low-protein foods (5%), dietary supplements (2%), and feeding supplies (3%). Bonferroni-adjusted post hoc tests indicated that modified low-protein foods were the only product type for which parents overall reported paying in excess of $100/month more often than they paid <$100/month (medical foods: χ2 (1, N = 224) = 59.93, P < 0.005; modified low-protein food: χ2 (1, N = 165) = 0.30, P >0.005); dietary supplements: χ2 (1, N = 123) = 73.37, P < 0.005; and medical feeding supplies χ2 (1, N = 120) = 93.6, P < 0.005). Although the majority of parents purchased multiple product types to fully meet the medical needs of their children, we were not able to determine the additive OOP costs for those parents due to the categorical nature of the response options.


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)

Cost per month paid OOP for medical foods and related productsPercentage of families reporting OOP expenditures for medical foods, dietary supplements, modified low-protein foods, and feeding supplies is noted on the y axis. Families often paid for more than one product type. Families reported the range of costs they paid per month beyond insurance or other coverage for medical foods, modified low-protein foods, supplements, and supplies. Shown here are the ranges of OOP expenditures for each type of product (on the x axis); OOP, out of pocket.
© Copyright Policy
Related In: Results  -  Collection

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

Figure 2: Cost per month paid OOP for medical foods and related productsPercentage of families reporting OOP expenditures for medical foods, dietary supplements, modified low-protein foods, and feeding supplies is noted on the y axis. Families often paid for more than one product type. Families reported the range of costs they paid per month beyond insurance or other coverage for medical foods, modified low-protein foods, supplements, and supplies. Shown here are the ranges of OOP expenditures for each type of product (on the x axis); OOP, out of pocket.
Mentions: Figure 2 shows the percentage of parents reporting OOP expenditures by product type. χ2 Test results indicated that across product types there were statistically significant differences in the distribution of OOP expenditure levels for the different types of products (χ2 (9, N = 632) = 141.27, P < 0.005). A total of 21% of parents purchasing medical foods paid more than $100 per month (beyond the costs for an unaffected child), as did 48% of parents purchasing modified low-protein foods, 11% purchasing dietary supplements, and 6% requiring feeding supplies. Some families reported paying $500 or more for medical foods (4%), modified low-protein foods (5%), dietary supplements (2%), and feeding supplies (3%). Bonferroni-adjusted post hoc tests indicated that modified low-protein foods were the only product type for which parents overall reported paying in excess of $100/month more often than they paid <$100/month (medical foods: χ2 (1, N = 224) = 59.93, P < 0.005; modified low-protein food: χ2 (1, N = 165) = 0.30, P >0.005); dietary supplements: χ2 (1, N = 123) = 73.37, P < 0.005; and medical feeding supplies χ2 (1, N = 120) = 93.6, P < 0.005). Although the majority of parents purchased multiple product types to fully meet the medical needs of their children, we were not able to determine the additive OOP costs for those parents due to the categorical nature of the response options.

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