What Is a Feeding Tube, and How Do I Get Insurance to Pay for One?

There are a lot of misunderstandings out there about what is a feeding tube, why and how it is used, and how to obtain feeding tube supplies. In this article, we’ll go through the basics and must-know info surrounding feeding tubes.

We have been providing patients with enteral feeding and nutrition supplies and helping our customers get covered by insurance since 1984. In this post, I’ll share what we’ve learned in all those years.

First, let’s start with the basics of feeding tubes and feeding tube supplies, then we’ll get into the nitty-gritty of how to get your insurance company to pay for one.

What is a feeding tube?

A feeding tube is a flexible, medical grade tube that delivers essential nutrition to your body when consuming food by mouth is not an option. The feeding tube, also known as an enteral tube, carries a tube feeding formula into the body.

A feeding tube

 

What is tube feeding formula?

Tube feeding formula, also known as tube feed, is a formulation of liquid nutrients to provide your body with the nutrition it needs via a feeding tube. The tube feed formula will contain all the essential macro and micronutrients your body requires, including carbs, fat, protein, vitamins and minerals, and water for hydration.

Your body can digest tube feeding formula the same way it digests food eaten by mouth.

 

What is enteral feeding? The basics of tube feeding

Types of feeding tubes

A feeding tube is a medical device that delivers nutrition “enterally” to patients who are unable to eat by mouth. There are several different types of feeding tubes that serve different purposes.

Nasogastric feeding tube (NG): The feeding tube is inserted through the nose, down the esophagus, into the stomach. It is typically used for short-term (6-8 weeks max) tube feeding.

Nasojejunal feeding tube (NJ): The tube is inserted through the nose, down the esophagus and into the small intestine, or jejunum, via the stomach. This is used most often for short-term feeding (6-8 weeks) when the patient’s stomach isn’t able to handle receiving the tube feed directly.

Gastrostomy tube: The feeding tube is surgically inserted (through a small incision) into the stomach. This is used when a patient needs a feeding tube for long-term use.

Jejunostomy tube: The tube is surgically inserted directly into the bowel. The tube is connected to a machine which pumps liquid nutrition either continuously or food is syringed into the tube by hand. This is also meant for long-term use.

Who needs a feeding tube and why?

There are many types of patients who require feeding tube supplies. Among the most common are: premature babies in the NICU, patients in the ICU or in comas, people with severe eating disorders, or people with autism, dementia, dysphagia and severe gag reflex. (Side note: Many parents feel undue stress when their children will not eat; however, pickiness does not require a feeding tube!)

Types of tube feeding formulas

There are three common types of formulas that are fed through feeding tubes: intact, hydrolyzed, and modular. The type of formula used depends on the patient’s needs, condition and ability to digest and absorb protein.

How long should you use a feeding tube?

A feeding tube can be either permanent or temporary. A doctor is the only one who can diagnose the need for a feeding tube and the length of time it will be required. Doctors also prescribe the type of nutrition that must be fed by the tube. These instructions must be followed exactly.

How not to use a feeding tube

Never put anything into the tube other than what is medically specified. Enteral nutrition is a medical supply that must be stored and dosed properly. It is specially formulated to provide all of the calories, nutrients, and hydration for someone who can not eat or drink.

A feeding tube is not the place for regular food (not even pureed). It is not the place to inject medicines unless specified by the doctor. It is a surgically inserted medical device and must be treated as such.

Where to buy feeding tubes and feeding tube supplies

It is easier than ever to buy feeding tubes online.

You can shop enteral feeding supplies for adults here.

You can shop feeding tube supplies for kids here.

 A physician holds a feeding tube

Getting insurance to pay for feeding tube formula, feeding tubes

There are lots of rules and regulations surrounding feeding tubes, and they can be confusing and frustrating. Insurance companies are very particular about when they will pay for feeding tube nutrition. As a long-standing medical supply company, we can shed a little light on those rules.

Many times, severely autistic children or adults with severe dysphagia cannot take food or liquid by mouth. If this has been medically diagnosed and a feeding tube has been recommended, please keep the following in mind when getting supplies: If anyone tells the DME or insurance company that the person can take or will sometimes take food or liquid by mouth, the feeding tube WILL BE DENIED.

Insurance will only cover feeding tubes if the patient is 100 percent tube fed for all nutrition and liquids. This means that you can never feed the patient by mouth. If a DME company is told a patient can take even a spoonful of liquid orally, they legally cannot provide the feeding tube, and all the materials will have to be paid for out of pocket.

For this reason, enteral nutrition is usually unflavored. Since — in enteral feeding — the mouth, tongue, and taste buds are completely bypassed, flavor is not an issue. Insurances will also deny payment for feeding tube supplies if the patient is given a flavored food. This is only an issue if the feeding tube formula can also be taken orally by patients without a feeding tube.

There are different regulations depending on the person’s insurance, age, need, and ability. For some people who are continuously tube fed, insurance will cover a backpack that holds the feeding pump. Some insurance companies will also cover gravity bags. These hold the enteral nutrition while it hangs by an IV drip. However, because a gravity bag only delivers nutrition intermittently and not continuously like a pump, other insurance companies deem them “not medically necessary.” Those companies typically only pay for syringes, which can also be used to feed a patient intermittently.

The rules are complicated, and there are a lot of them. For this reason, it’s a good idea to contact your DME company and ask them questions. After all, that is why they are there: to help you.

Does Medicaid cover enteral nutrition?

Navigating Medicaid and feeding tubes can be stressful and complicated — and as we explained above, it can be a hassle to get insurance to cover enteral nutrition.

Legally, Medicaid and WIC MUST cover enteral formulas if they are medically necessary. That means, like we explained before, that Medicaid may refuse to cover a feeding tube and feeding tube supplies if the patient is able to consume any amount of food by mouth.

Your eligibility for Medicaid will vary from state to state, but most low-income families are eligible. Children with disabilities, medical issues, or special needs may qualify for a Medicaid waiver which will allow Medicaid to become a secondary insurance provider.

Feeding Tube Awareness has a guide on Medicaid and Medicaid waivers for feeding tubes.

feeding tubes

State laws about Medicaid and enteral nutrition

At the time of this writing, 18 states have a written mandate requiring Medicaid to provide enteral formula coverage. These states are:

Arizona
Connecticut
Kentucky
Illinois
Maine
Maryland
Massachusetts
Minnesota
Missouri
Nebraska
New Hampshire
New Jersey
New York
Oregon
Pennsylvania
Rhode Island
Texas
Washington

It’s important to remember that state-funded insurance plans don’t always need to follow state laws surrounding coverage. Additionally, some state mandates are written more generally than others, meaning you don’t have an across-the-board guarantee of approval.

The American Partnership for Eosinophilic Disorders has a robust guide on formula coverage as well as a breakdown of enteral nutrition coverage laws state by state.

How to appeal an insurance denial for a feeding tube

If you apply for enteral nutrition coverage and you are denied by your insurance provider, you can and should appeal said insurance denial.

Go to your doctor or medical specialist who can write a letter of medical necessity outlining why a feeding tube is imperative to treat your or the patient’s medical condition. The letter should detail the medical consequences that would occur without the feeding tube and tube feeding formula.  

Some tube feeding formula companies have created templates to help you appeal an insurance denial. Here is one from Neocate and one from Nestle Health Science.

 


SuLauren Wilson is the founder of Finnegan Medical Supply, an online medical supply store based in Little Rock, Ark. She blogs regularly on issues affecting the company’s patients.

POSTED ON: September 02 2014
Posted by:Su-Lauren Wilson owner,CFO
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