Prescription for Ensure Plus & insurance

[Stacy9402]

My daughter lost 8 pounds from her visit in May of 2010 to a visit in Nov 2010. She is 16 almost 17and has always been under 100 pounds. But she had got up to 98 and went back down to 90. So of course we were concerned. The doctor ran tet and everything came back normal except her thyroid was a little under active but the doctor said not something to worry about but then we were baffled because she should have been gaining weight with that problem. The only thing that changed was that she was put on Junel for ovarian cyst problems in June. So we have changed her to the patch for now. She does do softball as a sport but eats before, during and after practices and games. The coaches have always teased her in a good way because she is always eating. I call her the bottomless pit. But other than her softball which at the moment is only 2 times a week for an hour she really does not exercise except she walks to the school everyday and that only takes 5 minutes to walk. So the doctor wants her to drink Ensure Plus and so I have been buying it but it is really expensive. $10 for 6 bottles and she does like the chocolate so she drinks one in the morning after with her breakfast which is usually a bowl of cereal and fruit. and she drinks another before bed.

So far she has gained 10 ounces back - December weight check. We go back in Feb. and the goal is for her to have gained 2 pounds.

Someone mentioned to me that their mother got a prescription for Ensure Plus. So my question is - Will insurance pay for her to have this?

 

[DisneyCowgirl]

I haven't dealt with Ensure before, but did get insurance to cover other items ordered by the doctor that are not normally covered. Had to get a written prescription or a letter of necessity or something like that from the doctor.

If I recall correctly, I called the insurance company, was initially told no, but I just kept insisting that it was being ordered by the doctor until I got someone who helped me. (Not that I just hounded them into submission, just had to get someone able to answer something other than a run-of-the-mill question.)

If that doesn't work, do you have a medical flexible spending account? With a prescription, I think you can get that reimbursed through that, which at least means some savings.

Good luck!

 

[undertheradar]

Have you met with an endochrinologist(sp?) about this? Just thinking that some deeper testing may be required.

 

[Sadie22]

I haven't dealt with Ensure before, but did get insurance to cover other items ordered by the doctor that are not normally covered. Had to get a written prescription or a letter of necessity or something like that from the doctor.

If I recall correctly, I called the insurance company, was initially told no, but I just kept insisting that it was being ordered by the doctor until I got someone who helped me. (Not that I just hounded them into submission, just had to get someone able to answer something other than a run-of-the-mill question.)

If that doesn't work, do you have a medical flexible spending account? With a prescription, I think you can get that reimbursed through that, which at least means some savings.

Good luck!

This is good advice and I hope it works for you. Since this is a meal replacement item be prepared for it to not be covered since you would be buying other foods anyway.

Around here Ensure goes on sale all the time in various drug stores, supermarkets, Target, and Walmart for less than the cost you stated. Perhaps a manager could give you a case lot price. There are also newspaper coupons available from time to time and I get a register coupon printed every time I buy some. A coupon site like Coupon Mom might be able to tell you when there are good deals out. I buy this stuff for my mom. She developed a taste for it when my dad had to have it.

 

[Stacy9402]

No we have only met with the Pediatrician so far. She is going to go to a genetics person at John Hopkins but that appt is March 1st. We have hypermobility and so they are checking deeper into that.

 

[Straitlover]

If you don't mind shopping at WalMart, you can get the Equate version of Ensure Plus for 6.67 (or 6.97, one of those!). My mother is doing chemo right now, and this is what I am buying for her. I've been trying to find something online in bulk for cheaper, but this is the best price I've come across.

Also, you can buy one of those big containers of whey protein and mix it in smoothies, ice cream, etc, for some extra calories for cheaper.

 

[Juliegirl1]

Also check Sam's or Costco - they usually have it or another brand of something similar. My son likes to drink it and since he is underweight and doesn't like to eat I give it to him a lot - he prefers the off brands like Fortify (Kroger) and Equater (Walmart) better than the Ensure itself and since it's a store brand it's usually cheaper.

 

[daughtersrus]

My daughter lost 8 pounds from her visit in May of 2010 to a visit in Nov 2010. She is 16 almost 17and has always been under 100 pounds. But she had got up to 98 and went back down to 90. So of course we were concerned. The doctor ran tet and everything came back normal except her thyroid was a little under active but the doctor said not something to worry about but then we were baffled because she should have been gaining weight with that problem. The only thing that changed was that she was put on Junel for ovarian cyst problems in June. So we have changed her to the patch for now. She does do softball as a sport but eats before, during and after practices and games. The coaches have always teased her in a good way because she is always eating. I call her the bottomless pit. But other than her softball which at the moment is only 2 times a week for an hour she really does not exercise except she walks to the school everyday and that only takes 5 minutes to walk. So the doctor wants her to drink Ensure Plus and so I have been buying it but it is really expensive. $10 for 6 bottles and she does like the chocolate so she drinks one in the morning after with her breakfast which is usually a bowl of cereal and fruit. and she drinks another before bed.

So far she has gained 10 ounces back - December weight check. We go back in Feb. and the goal is for her to have gained 2 pounds.

Someone mentioned to me that their mother got a prescription for Ensure Plus. So my question is - Will insurance pay for her to have this?

It's unlikely that insurance will pay for it. My DD (16 1/2yo) is very small for her age both in height and weight. We just weighed her 2 days after Christmas and she was a whopping 48lb.(she's also 48 inches tall) She does have a rare genetic disease but size is not a known symptom.

We've tried everything to get her to gain weight. She eats like a pig but just can't put weight on. A nutritionist actually suggested to us to give her Carnation Instant Breakfast with whole milk instead of Pediasure because it has more calories ( but not as many vitamins). There are also products that you can add to food that will add calories but not change the taste.

When we started on this journey, I contacted the phone# on the packages. The rep from Nestle Nutritional was very helpful. We talked for a bit and she asked if I would like some samples. Of course I said yes. To my surprise, UPS brought me cases of several of their products. It may be worth it to give the companies a call. If nothing else, they may offer you some coupons.

We have not been able to get our insurance to cover any nutritional supplements (they did say that they would cover a feeding tube but not the formula to go into it) or diapers. They've determined these things to be a parental responsibility.

I hope that you get some answers and that she's able to gain some weight.

 

[Redwitch]

Boost, a similar product, will send you a dollar coupon monthly. You need to call every month. They have a "plus" version that is high in calories and available in chocolate. Boost runs about $8.99 six pack here, but it is often a CVS deal. Last week it was $5.99 with 1 ECB back. As mentioned, Carnation Instant Breakfast is also a wonderful addition to increase caloric intake.

 

[Mono~rail]

My daughter lost 8 pounds from her visit in May of 2010 to a visit in Nov 2010. She is 16 almost 17and has always been under 100 pounds. But she had got up to 98 and went back down to 90. So of course we were concerned. The doctor ran tet and everything came back normal except her thyroid was a little under active but the doctor said not something to worry about but then we were baffled because she should have been gaining weight with that problem. The only thing that changed was that she was put on Junel for ovarian cyst problems in June. So we have changed her to the patch for now. She does do softball as a sport but eats before, during and after practices and games. The coaches have always teased her in a good way because she is always eating. I call her the bottomless pit. But other than her softball which at the moment is only 2 times a week for an hour she really does not exercise except she walks to the school everyday and that only takes 5 minutes to walk. So the doctor wants her to drink Ensure Plus and so I have been buying it but it is really expensive. $10 for 6 bottles and she does like the chocolate so she drinks one in the morning after with her breakfast which is usually a bowl of cereal and fruit. and she drinks another before bed.

So far she has gained 10 ounces back - December weight check. We go back in Feb. and the goal is for her to have gained 2 pounds.

Someone mentioned to me that their mother got a prescription for Ensure Plus. So my question is - Will insurance pay for her to have this?

My dd is 5 now and has been on Pediasure since she was 1 so this is an area I have experience with. You might want to post this over on the DISabilities board. Lots of experienced parents over there.

My dd has a feeding tube. We have had 4 different insurances since she was born. Only one ever covered her Pediasure and that was Blue Cross Blue Shield of California. It had to come from a home medical supplier. For over 4 years she was tube dependent for all her nutrition so her intake was 4-5 cans/day. For insurance to reimburse it had to be very specific diagnosis codes.

Before we got the insurance that covered it, we bought store brand. I compared labels and they are equivalent. Store brand saved us quite a bit.

Our current insurance doesn't cover it, but she only gets 2 cans/day now which is given at night. We're back to store brand. Look for sales and coupons. Compare prices and watch for deals.

Good luck to you and your daughter!

 

[Stacy9402]

Thanks everyone. I am going to try to call the company and see what they will send. She has done the Carnation Breakfast drinks but it did not make her gain any weight. She actually had drank some of them during the time she lost weight. Hopefully Ensure will help her at least maintain weight but I am going to try to get the doctors to do more test to see if there is an underlying cause.

But thank you everyone. I got alot of great ideas..

 

[Swimalie]

I would check Costco, BJ's or Sams if you can. I know they sell it there. My husband drinks it as a meal replacement when he works out at work.

When I was around her age (18, I think), the doctor put me on Ensure as well. I was on it for a year and only gained 2 pounds. I gave up at that point. When I was 24 I was diagnosed with Graves Disease, an overactive thyroid. If you don't mind posting, please tell me what thyroid tests the pediatrician ran? A lot of non-endocrinologists don't run all 3 or 4 test needed to verify a thyroid disorder. They think 1, the TSH will see if there is a thyroid problem and it's just not enough.

 

[mrudman]

Just curious.. how tall is she?

I was always very thin around that age also.. was 5'2", 90 lbs (give or take), up till i was around 18 yrs old.. remember finally hitting 100 lbs when i was just over 18.

Was nothing medically wrong with me.. just had a high metabolism.. and now 20 yrs later, still have a fairly high metabolism.. so could it just be that?

Not saying you definitely shouldn't try to get her to gain a few lbs with the nutritional supplements suggested.. especially since she had lost a few lbs... but could it be that over summer (since weight loss was from may to october), she had been more involved in sports/outdoor activities, and body burning off more than she was eating?