Anthem

Anthem is a leading provider of health benefits and serves more than 106 million people. One in eight people in America receive coverage through Anthem or their affiliated plans.

One of the many important services Anthem provides is benefits for baby formula. For babies who are born with a metabolic disorder and need special modified low-protein food products, Anthem can and will cover the cost of that insurance covered baby formula.

In order to qualify for specialty formula through Anthem, the formula must be manufactured for patients with diseases caused by inborn errors of metabolism.

Additionally, Anthem Insurance will provide coverage for baby formula for medically necessary amino acid-based elemental baby formula for children two years and younger.

In order to qualify for baby formula through Anthem, it is important that a licensed physician diagnosed the baby during a physical medical exam and that they documented for Anthem Insurance one of the following conditions:

  • Symptomatic allergic colitis or proctitis
  • Laboratory – or biopsy-proven allergic or eosinophilic gastroenteritis
  • A history of anaphylaxis’
  • Gastroesophageal reflux disease that is nonresponsive to standard medical therapies
  • Severe vomiting or diarrhea resulting in clinically significant dehydration requiring treatment by medical provider
  • Cystic fibrosis
  • Malabsorption of cow milk-based or soy milk-based infant formula.

In order to have coverage through Anthem Insurance for amino acid-based baby formula, it must be authorized by a physician who confirms and signs the documents. Insurance Covered Baby Formula can help with this. If you fill out our Am I Covered form, our insurance specialists will work with your pediatrician to get authorization and work with Anthem insurance to confirm coverage.