Insurance Checklist

INSURANCE QUICK TIPS:
  • Be prepared: Ask you doctor to write a prescription for your Functional Formularies product. Bring to your doctor’s visit: a sample referral form and letter of medical necessity.

  • Research: Find a DME that takes your insurance and carries Functional Formularies products.

  • Make the call: Ask the insurance company what they need for coverage.

  • If denied: Request a written letter from the insurance company.

  • We are here to help: We have patient advocates available to help assist you in gaining insurance coverage for our products. Please contact us.

Use the suggested checklist below to help you gather what you need BEFORE sending to a DME:
  • We have an insurance specialist on staff, free of charge, to help with the insurance and Medicare/Medicaid approval process. We are the first organic enteral formula to be approved by Medicare. The Medicare billing code for Liquid Hope and Nourish is: B4149—Blenderized Natural Foods with Intact Nutrients.

  • Letters of Medical Necessity.

  • Recent progress notes (within six months) from your doctor.

  • A nutrition assessment treatment plan for Functional Formularies products from a registered dietitian, nutritionist, or a physician.

  • Referral form completed by your doctor, nurse practitioner, or physician assistant. This is NOT considered a prescription. (print from insurance page and give it to your doctor).

  • Copies of patient insurance cards, front and back.

  • YES! Liquid Hope, Liquid Hope Peptide, Nourish, Nourish Peptide, and Keto Peptide are all covered by private insurance, Medicare and Medicaid. We have an insurance specialist on staff, free of charge, to help those using Liquid Hope and Nourish with the insurance and Medicare approval process. We are the first organic enternal formula to be approved by Medicare. The Medicare billing code for Liquid Hope and Nourish is: B4149—Blenderized Natural Foods with Intact Nutrients.
  • Send an email to insurance@functionalformularies.com to start the process. Please read our page on insurance for more information. ** Medicare, Medicaid and health insurers may ask you to provide a National Drug Code/NDC number for insurance claims, billing or reimbursement purposes. Because our products are whole foods and do not constitute “drugs”, we have an Insurance Data Bank and Billing Code that you should use when asked for an NDC number for our products.

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