Insurance Coverages
Kitchen Blends Meals may be covered by your private or public health insurance plan. You can find out if your insurance plan covers Kitchen Blends Meals by contacting your insurance provider directly. Ask if your plan covers HCPCS B4149. You may also contact your durable medical equipment (DME) supplier.
Find a DME Near You
To find a DME supplier in your area, follow this link and complete the form.
If your insurance provider will cover Kitchen Blends Meals, follow these steps to get your meals covered.
1. Get a prescription from your doctor.
2. Contact your DME supplier.
3. Order your Kitchen Blends Meals.
The DME supplier will bill your insurance provider and ship your meals to you.
Medicare Coverage Guidelines
Medicare patients can receive coverage for Kitchen Blends Meals with documented proof of medical necessity. If you believe you fit the criteria for coverage, contact your current healthcare provider or your DME supplier.
In order for Medicare to cover your tube feeding products in your home, you must meet the following criteria:
- Your tube feeding is considered permanent or will be needed for at least 3 months.
- Your tube feeding is needed because you are unable to safely eat enough foods by mouth or you are not able to digest and absorb enough nutrients to maintain your weight.
In order to receive Medicare coverage for Kitchen Blends Meals, you must prove documented intolerance to standard and elemental formulas.
Standard Formula: A standard formula is one that is nutritionally complete with intact nutrients (HCPCS B4150 or B4152) and deemed appropriate for the majority of individuals requiring enteral nutrition.
Elemental Formula: Special formulas typically known as elemental formulas are ones in which the nutrients are broken down into smaller molecules to aid in digestion for individuals who were not able to tolerate a standard formula.
The medical necessity for specialty elemental enteral formulas (B4153, B4157, B4161, and B4162) must be justified for each beneficiary. If a special enteral nutrition formula is provided and if the medical record does not document why that item is medically necessary, it will be denied as not reasonable and necessary.
Required Documentation
Kitchen Blends Meals are specialized products in which Medicare requires additional documentation from your healthcare provider. This documentation needs to clearly explain why you need Kitchen Blends Meals versus standard tube feeding formulas. For example, if you, or the person you care for who tube feeds tried both a standard formula and an elemental formula, and you or they were unable to tolerate it, this is what needs to be documented.
It is important that your medical records support the reason you or the person you care for needs the tube feeding and why Kitchen Blends Meals specifically are necessary nutritional supplies. The most effective documentation will come from physician progress notes or your dietitian's notes because these discuss the condition of the person who tube-feeds and their ability to process other feeding options due to the condition.
Furthermore, if it is difficult to obtain the documentation needed to support coverage, your physician can write a progress note that explains the history of your condition. It must be in progress note form and not a physician letter.
The Difference Between Being Covered and the DME Supplier Actually Supplying
Coverage means that you meet the enteral Medicare guidelines and have the opportunity to have your supplies covered by a DME supplier. If a DME supplier is willing to bill Medicare on your behalf, they are accepting assignments for all the supplies needed. The DME supplier does have the right to refuse to bill on your behalf or refuse to accept the assignment. If you are notified by your DME supplier that they are refusing to bill for your supplies, it is your right to ask them why.
Denials for Kitchen Blends
If you were informed by your DME supplier that you do not have coverage for Kitchen Blends Meals or have been denied by your insurance provider, it is important to understand why.
If your DME supplier has told you they cannot provide Kitchen Blends, please ask:
Why can't you provide me with Kitchen Blends Meals?
- Is this because my insurance has denied the claim?
- Is this because you are not familiar with the product or you don't stock it?
- Is this because you are unwilling to provide me with Kitchen Blends Meals due to reimbursement levels?
Insurance Denial
If your DME supplier tells you that your insurance provider denied the claim, it is imperative that you ask for this denial in writing from your insurance provider. Often, if insurance has been denied, it is due to a lack of medical documentation to support coverage. In this case, ask your physician to provide the appropriate documentation.
Some insurance plans do not offer coverage for this HCPCS code. In this case, if you are currently receiving coverage for standard or elemental formula, it may be worthwhile to contact your insurance provider and ask for an exception due to the medical necessity. In some cases, the insurance company will accept the claim in order to avoid having to pay for more expensive specialized formulas.
DME Supplier Does Not Stock Kitchen Blends
If this is a covered benefit, you can discuss with your DME supplier why they are unwilling to stock Kitchen Blends. Ask to speak with a supervisor within the department. Oftentimes, a customer's request is enough to prove there's a demand for supply.
DME Supplier Won't Provide Kitchen Blends Because Reimbursement Rates are too Low
If the DME supplier indicates that not stocking or providing you with Kitchen Blends Meals is a business decision, please have them contact Kitchen Blends to discuss the reimbursement and wholesale rates.
You can also submit directly to your insurance provider for reimbursement. If you choose this route, contact your insurance provider directly to learn the process.
Frequently Asked Questions (FAQs)
What is a DME supplier?
Durable Medical Equipment (DME) suppliers hold contracts to bill insurances for medical equipment used at home, including tube-feeding formulas. They coordinate and purchase medical supplies and equipment, bill your insurance and ship to your home.
I'm selecting a new plan, how do I check if Kitchen Blends Meals are covered?
Contact your insurance provider plan administrator and inquire if there is coverage for HCPCS B4149. And while you have their attention, ask for the requirements for this code—some insurers only require a letter from your doctor, others might require proof of failing other (cheaper) formulas.
What is proof of medical necessity? I have a feeding tube, isn't that enough?
Unfortunately, for some insurance plans, you need to have proof that current or previous formulas are ineffective before Kitchen Blends will be covered. Many people who tube feed will have no problem proving this. Ask your physician for any or all of the following items to show that the tube-fed person is not tolerating typical formula:
- Weight charts
- List of medications to help motility, reflux, constipation, or diarrhea
- Any notes in the medical record that refer to vomiting, nausea, bowel issues, reflux management, other changes in formula, lack of weight gain/weight loss, etc. All of these can be seen as proof that typical formulas have not been tolerated.
Can I pay for Kitchen Blends with my Health Savings Account or Flexible Spending Account? Can I write off the meals as a medical expense?
Most likely, yes. Contact your health insurance provider's plan administrator to discuss eligibility, and discuss potential deductions with your accountant. We can provide a detailed receipt for your tax keeping records if needed. Please email us at [email protected] to make a request.
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