Overview of formula 4 success®

Hello, my name is Kristen, and I am excited to be part of the formula4success® team! I have worked in the healthcare industry for over 10 years and my mission is to assist patients, healthcare providers and loved ones with insurance related challenges. I am eager to listen to people’s needs, solve complex insurance questions, and help patients and caregivers understand the issues involved. I am here to help with locating suppliers and to assist with financial questions or concerns. I work with both consumers and medical professionals, and I strive to give the best customer care possible to everyone I assist. When I am not working with formula4success® I am spending time with my family, we love going on long walks with our dogs and traveling any chance we get.

The formula4success® Reimbursement Specialist will gather your insurance information and contact your insurance plan to verify coverage for Nestlé formula. The expert formula4success® Reimbursement Specialist will obtain the following information:

• Eligibility
• Benefit / Coverage Status
• Out-of-pocket Responsibility (co-insurance and deductible amounts)
• Payer Coverage Policy (including coverage requirements and/or restrictions)

In addition, your dedicated formula4success® Reimbursement Specialist will obtain details on all forms and documentation required by your health plan. Throughout the process, the formula4success® team will keep you and your healthcare provider updated on the status of your case and the benefit investigation.

The formula4success® Patient Reimbursement Support Program provides assistance prior to, and during, submission of a claim for reimbursement. Your dedicated formula4success® Reimbursement Specialist will help navigate the payers specific claims submission process including creating a claim packet with the correct forms and medical justification from your healthcare provider to support coverage for enteral nutrition.

The formula4success® Patient Reimbursement Support Program provides assistance after a claim has been submitted and subsequently denied by your insurance plan. Your dedicated Reimbursement Specialist will:

• Investigate the claim denial to identify potential errors or deficiencies
• Provide this information to you and your healthcare provider
• Verify the appeal process with your insurance plan and obtain any forms required for submission of an appeal

Throughout the appeal process, formula4success® will maintain close communication with the you and your healthcare provider.

In conjunction with Nestlé Health Science, formula4success® maintains a network of national and regional home care providers, pharmacies, distributors, HME/DME and home infusion companies. Your formula4success Reimbursement Specialist can:

• Provide contact information for providers in-network with your insurance and online options.
• Connect you with an in-network provider of your choosing.
• Provide you with options for purchasing your Nestle formula online.

If during the Benefit Verification process the formula4success® Reimbursement Specialist determines your health plan requires Prior Authorization for coverage of a Nestlé formula, your Reimbursement Specialist will:

• Determine the Prior Authorization process, forms and medical documentation required by your insurance plan
• Inform your physician of the requirements for Prior Authorization
• Provide template Letters of Medical Necessity for your physician to complete and submit on your behalf as necessary