pointsbta.blogg.se - Enfamil physician samples

(b) Subject to Subsection (c), the coverage required under Subsection (a) is required if the treating physician has issued a written order stating that the amino acid‑based elemental formula is medically necessary for the treatment of an enrollee who is diagnosed with a disease or disorder listed in Subsection (a). (4) impaired absorption of nutrients caused by disorders affecting the absorptive surface, functional length, and motility of the gastrointestinal tract. (3) eosinophilic disorders, as evidenced by the results of a biopsy and (2) severe food protein‑induced enterocolitis syndrome (1) immunoglobulin E and non‑immunoglobulin E mediated allergies to multiple food proteins

> Requires insurance coverage for amino acid-based elemental formulas for treatment of eosinophilic disorders.Ĭoverage for Certain Amino Acid Based Elemental Formulas.Ī) A health benefit plan must provide coverage as provided by this chapter for amino acid‑based elemental formulas, regardless of the formula delivery method, that are used for the diagnosis and treatment of:.

(1) Each health benefit plan issued or renewed after December 31, 2015, must offer benefits or coverage for medically necessary elemental formula, regardless of delivery method, when a licensed physician or other health care provider with prescriptive authority: (2) Nothing in this section prohibits a health benefit plan from requiring prior authorization or imposing other appropriate utilization controls in approving coverage for medically necessary elemental formula.

(b) Orders and supervises the use of the elemental formula. (a) Diagnoses a patient with an eosinophilic gastrointestinal associated disorder and

(1) Each health benefit plan offered to public employees and their covered dependents under this chapter that is not subject to chapter 48.43 RCW and that is issued or renewed after December 31, 2015, must offer benefits or coverage for medically necessary elemental formula, regardless of delivery method, when a licensed physician or other health care provider with prescriptive authority:

> Any health plan issued or renewed after December 31, 2015, must cover medically necessary elemental formula for eosinophilic gastrointestinal associated disorders, with any cost sharing applied to the out-of-pocket maximum set forth in the plan.