What Is a Feeding Tube, and How Do I Get Insurance to Pay for One?
There are a lot of misunderstandings out there about feeding tubes, and we’d like to clear some of them up. Since 1984, our sister company, Finnegan Health Services, has been providing patients enteral feeding and nutrition supplies and has been helping to get them covered by insurance. In this post, I’ll share what we’ve learned in all those years.
First let’s start with the basics of feeding tubes, then we’ll get into the nitty gritty of how to get your insurance company to pay for one.
What is enteral feeding? The basics of tube feeding
- A feeding tube is a medical device that delivers nutrition “enterally” to patients who are unable to eat by mouth. Sometimes, the tube is inserted through the nose, down into the stomach. Other times, it 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.
- There are many types of patients who require feeding tubes. 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!)
- 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.
- 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.
- 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.
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. Please feel free to comment on your experiences with feeding tubes. Have you found ways to make dealing with insurance less complicated?
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.