enterade® may be eligible for reimbursement from health insurance plans.
Coverage depends on the insurance provider and plan. Check with your insurance company to see if they cover medical foods when prescribed for a medical need. enterade must be used to treat a medical condition and be prescribed by a licensed healthcare professional to treat an illness or condition.
As the manufacturer, enterade cannot bill insurance directly.
For information regarding FSA/HSA reimbursement, see below.
To check if enterade is covered by your insurance plan, follow the steps below:
1.
Call your insurance carrier
Patient calls member services line or provider calls provider line and lets them know enterade is ordered and calling to check if it is covered.
2.
Provide the NDC code
to the insurance carrier
enterade® IBS-D Mixed Berry
NDC Code 60008-0321-11
3.
Insurance Carrier will let the Patient Know if enterade is Covered
4.
IF COVERED:
Ask what they need: prescription, clinical notes, and/or letter of medical necessity. Ask if you can purchase product directly from manufacturer and submit for reimbursement with a claim form
If enterade is covered, obtain a prescription from a physician or a health care provider
1.
The Rx Needs to Include Patient’s Name,
Date of Birth, & Diagnosis
2.
Sample Rx
enterade 2x/day x 30 days plus 2 refills
3.
Needs to Include Diagnosis/Reimbursement Codes
(ICD 10)
Code Examples:
a. Irritable bowel syndrome: K58.9
b. Diarrhea: R19.7
c. Electrolyte imbalance: E87.8
d. Dehydration: E86.0
e. Leaky gut syndrome: K59.9
For HCPs: If Prior Authorization is Required, Follow These Steps:
1.
Submit clinical notes
Include rationale for why this product is medically necessary
For Flexible Spending/Health Spending Accounts
enterade is covered by a FSA/HSA when prescribed by a health care professional to treat a medical condition
1.
Obtain a Rx for enterade as outlined above
sample Rx:
enterade 2x/day x 30 days plus 2 refills
2.
Purchase Product
on enterade.com or Amazon.com
3.
Submit to your FSA Carrier for Reimbursement
Submit prescription (including diagnosis and reimbursement code) & a copy of your receipt
