Insurance rejected request to cover enteral nutrition formula. Any ideas?

Although defined as medical food, the insurance rejected our request for coverage. We even sent the labs to prove the stuff was working, along with the medical necessity letter from the GI.
Any great ideas out there? Experience?
I am sure I will encounter the same problem with the VSL#3 (although it is also defined as Medical Food!!!!)

I'm not giving up on this, so any idea, no matter how wild, is welcome!

Warm wishes from sunny Miami

I do not want to debate what insurance companies are for...I work for one. I do know that an initial rejection does not mean a final rejection. I had a vitamin rejected once as OTC and simply called to explain in further detail that I had the prescription level. No agruments and it was done.
Each person within a company has an authority limit. They will reject items that exceed their authority limit. I would recommend that you make a call and ask to speak to the case management team (or the supervising nurse case manager) to discuss the medical necessity of this. The case management team is usually staffed by medical personnel who have a greater knowledge of medical review.

Finally, I do know that most coverages do not include supplemental nutrition. So if the patient is able to maintain on regular food, this may be considered supplemental nutrition.

These are just thoughts I had for you

I third the suggestion. If this is the first rejection, there should be an appeals process. I would keep it on a courteous basis for now (e.g., You understand this is a less-common treatment and realize they may need the opportunity to look over the data in more depth; you want to give them the opportunity to do so, etc.). If you did get to the point where you had exhausted all the appeals, then you could start looking beyond the company (e.g. state atty. general's office or insurance department or whoever regulates insurers in your state; your senator or representative, etc.). But I think you really do have a chance of prevailing if you just work through the standard appeals process within the company. If you need extra data, this recent review might be something useful to attach to the insurance submission:

http://www.ncbi.nlm.nih.gov/pubmed/19786755?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=4

On another note, she gained 17 pounds! Very impressive! I bet she's starting to look like a teenager, and is very happy about it.