- Medical diagnosis: A diagnosis or circumstance in which donor milk may provide a therapeutic benefit. Such conditions include, but are not limited to, malabsorption disorders, prematurity, short gut syndrome, congenital heart disease, renal disease, post-surgical nutrition, immunological deficiencies, failure to thrive, allergies, and formula intolerance. Please note that a diagnosis of formula intolerance must show at least three (3) formula trials, including hydrolyzed and amino acid/elemental formulas.
- Prescription from healthcare provider.
- Letter of medical necessity.
- Denial of coverage by the insurance plan of the recipient child.
- Recipient child must reside in Pennsylvania, West Virginia, New Jersey, Maryland, or Delaware.
The Medical Advisory Board of Mid-Atlantic Mothers’ Milk Bank considers each application based solely on medical need (financial and all identifiable patient information are kept private). The review process typically takes 3-4 days.
Length of Eligibility
The Medical Advisory Board of our milk bank determines the length of eligibility for the sliding scale program for each donor milk recipient based solely on the medical information provided by the family and health care provider.
In addition to a prescription from the recipient’s healthcare provider and completion of the registration forms, payment or arrangement of payment is required at the time of the milk order. Such arrangement includes payment by check/credit card or insurance preauthorization. We are aware that pre-authorization may take a few days, a peer-to-peer review may be necessary, or it may take time to gather the documents required for the sliding scale application. It is our policy to fill an order for a two-week supply of donor milk immediately for any baby with a medical need for donor milk. A second order will not be filled without insurance authorization, completion of the sliding scale program application (if applicable), and/or payment arrangements. Recipient families are responsible for the cost of the first and all later orders after insurance reimbursement and sliding scale adjustments.
It is very important that the recipient child’s healthcare provider requests insurance pre-authorization as quickly as possible. Orders placed before the pre-authorization request are typically not covered by insurance and are therefore the responsibility of the recipient family. The milk bank’s sliding scale program is retroactive however, meaning that the discount applies to all orders.
SLIDING SCALE FEE SCHEDULE
* Based on 2020 Federal Poverty Guidelines
For example, a family of three (two parents and an infant) that makes a gross (before taxes) yearly income of $55,000 would pay 40% of the milk bank’s current processing fee.