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How to get insurance coverage for elemental nutrition?
Hi all,
After years of crippling motility problems, I've developed some more symptoms that, together with some of my blood test results, seem suggestive of IBD, and I'm working with a new GI to find out if I have it. In the past few months, I've lost the ability to eat much solid food other than chicken, which has no fiber, because anything else gets stuck in my system behind what feels like a blockage in my right groin. I'm not sure how much longer I can keep doing this and am hoping to be able to go on the elemental diet soon - basically the oral equivalent of tube feeding - to get bowel rest and start healing my IBD, if that's what this is. However, most GIs and dietitians don't seem to have experience with patients on the elemental diet, and I'm at a loss as to how to get insurance coverage for it (I live in AZ by the way) - especially if I have to go with an OTC brand of elemental shakes, like Absorb Plus Amino orange/mango formula, which I'm currently looking at because it's the only option I've found so far that doesn't have ingredients derived from foods that I'm allergic to. It's insanely expensive, though!
Has anyone done the elemental diet before, and were you able to get insurance coverage for it? If so, what was the process like and what questions should I ask my insurance provider? Thanks in advance! This situation has me really overwhelmed.
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I’ve never heard of an elemental diet. I found out through a GI motility (4-6 hour) that I have colonic spasticity, not colonic inertia. Got an Ileostomy February 2025 due to severe constipation. Also in a very limited diet due to frequent SBO. I have Medicare which does not pay for any nutritional or dietary visits. I do have Protein Plus milkshakes. Mayo uses Ensure Impact Recovery in the hospital and recommends it pre and post op. It’s pretty expensive for ongoing use, but maybe less than the diet your diet talking about. I would love to know more about it. I have a GI Zoom call this afternoon with Mayo Rochester..I’ll ask her about it..
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4 ReactionsI have tried for my husband and so far been unsuccessful. In addition to the symptoms you listed he also has histamine flares to most foods at this point and severe acid reflux. He's drinking Cambrooke Essential Jr unflavored. Have you had any progress in your diagnosis? I feel like I could have written that same exact post for what he's been going through but we still don't even know what is wrong with him.
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2 Reactions@jessicaalbrecht I'm so sorry to hear what your husband is going through. I eventually found this page here that might help - it has information on elemental formula coverage laws in a lot of states and a link to a guide on how to talk to an insurance company about it: https://www.foodallergyawareness.org/living-with-food-allergies/statewide-insurance-coverage-for-elemental-formula/. At this point I still have not found a formula that will be safe for me, so I may not end up going that route, but I did get a diagnosis - I have Crohn's colitis. It's a type of Crohn's that behaves a bit like ulcerative colitis in the sense that it affects only my colon, and in my case it's located on the right side, where the blockage sensation was. I am on Budesonide and Entyvio for it now. The Budesonide got rid of the blockage feeling within a day or two, and my motility is improving now that I've started the Entyvio.