We Accept HSA Cards
1.Contact your insurance plan to determine if low protein foods are covered.
2.Use the medical code S9435(PKU & Homocystinuria). The ICD-10 diagnosis code for phenylketonuria (PKU) is E70.0. Ask if they are covered and to what extent they are covered.
3.Ask if you need to obtain an in-network authorization as most companies are out of network. This can also be called a Gap Exception.
4.You should know of any co-payments, coinsurance payments or deductibles that have not been met on your plan.
5.If you insurance company covers low protein foods, you will need to obtain a prescription and letter of medical necessity from your provider. Submit that to your insurance company with your request for an authorization.
8.If you have a self-insured plan they are not mandated to reimburse for low protein foods or medical (metabolic) formulas.
9.You will need our NPI# 1770718025 and Tax ID# 812438654 to put on the health insurance claim form.
- Your insurance company should have a health insurance claim form on their website.
- An itemized bill and receipts. This is important. It will be filed along with the health insurance claim.
- Make a copy of every single document you receive and put it into a file specifically marked for your claim
*If you cannot bill your insurance company directly, contact a Durable Medical Equipment (DME) store or pharmacy in your area. They can order your low protein food on your behalf and bill your insurance. Refer to our list of companies below in your state.
NPKUA Affiliate Council
They will provide support for PKU adults and families who are encountering insurance coverage issues for formula or low-protein medical foods. https://www.npkua.org/Resources/Insurance-Coverage-101
NORD PKU Patient Assistance Programs
NORD sponsors 2 PKU Patient Assistance Programs, the Premium/Copay Program and Medical Assistance Programs.
EBT/Food Stamps: We do not take food stamps, however you can contact a local store to see if they would purchase your low protein foods for you and and then you would pay the store directly with your food stamps, EBT card.
How Much Phe is an online subscription service which provides access to the Phe content for foods
https://howmuchphe.org/
The following are referals for state programs, pharmacies, pantries & stores
Alabama
Alaska
Arizona
Arkansas
California
CCPKUAD Virtual Pantry/ccpkuad@gmail.com
Myers Medical Pharmacy- 260 Hospital Dr Suite 111, Ukiah, California 95482 (707) 468-1866
Permanente Medical Group 275 West MacArthur Blvd, Oakland, California 94611
Cal Med Pharmacy- (213)413-2343 ext. 271
Colorado- https://strivecolorado.org/
Connecticut
Delaware
Florida- CMS/Sunshine Health (813)326-0596
Georgia- Catoosa Health Department- kimela.evans@dph.ga.gov
Hawaii
Idaho
Illinois
Indiana
Iowa- University of Iowa Div of Medical Genetics/ foodformulaprogram@uiowa.edu
Kansas
Kentucky- The Prescription Pad 465 Keene Centre Drive, Nicholasville, Kentucky 40356
For Metabolic Foods and Formulas program call: (502) 564-2154
https://www.chfs.ky.gov/agencies/dph/dmch/cfhib/Pages/kymffp.aspx
Metabolic Clinics In Kentucky
University of Louisville Metabolic Clinic - (502) 588-0850
University of Kentucky Metabolic Clinic - (859) 323-2513
Louisiana
Maine-
Maryland
Massachusetts- Massachusetts Dept of Public Health- pkuprogram@state.ma.us
Michigan
Minnesota
Mississippi
Missouri - Daily Living Home Medical Equipment/ jwtdollc@hotmail.com
Montana
Nebraska- State of NE Metabolic Foods dhhs.newbornscreening@nebraska.gov/(402)-471-9731
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon- OHSU (Oregon Health & Science University)
Pennsylvania- Glenwood Foods 1614 Division HWY, Ephrata, Pennsylvania 17522
Rhode Island
South Carolina
South Dakota
Tennessee
Texas- Texas DSHS New Born Screeing/NBSBenefits@dshs.texas.gov
Utah
Vermont
Virginia- Sentara Health Plans -kjmcgill@sentara.com
Washington
West Virginia
Wisconsin- WINNEBAGO COUNTY HUMAN SERVICES/gschiavone@winnebagocountywi.gov
Wyoming- Quality IV Care jenna@qualityivcare.com
The insurance billing services and information listed are for general information only. PKU Perspectives does not endorse any organizaion. Any link to an outside organization is not necessarily endorsed by our organization. The information is listed in good faith, however we make no representation or warranty of any kind, expressed or implied regarding the accuracy, adequacy, validity, reliability, availablility, or completeness as to the organizaitons listed above.
PKU Perspectives is committed to providing superior services. However, it's important to note that any loss or damage you might experience as a result of using our services falls under your responsibility. When you decide to use our services, you're acknowledging that you're doing so at your own risk. This is because our liability to you, in any circumstance, cannot extend to any loss or damage you might encounter. It's also crucial to understand that your decision to rely on any information you find on our site or use any services provided by the listed organizations is entirely your choice. Therefore, any outcomes from these actions are solely under your accountability.
