I am about 6 weeks out of takedown surgery and things are going relatively well. I am obviously aware of the importance of the Visbiome probiotic at this point and my surgeon wrote me a prescription for it but my insurance is still refusing to cover it. I have seen a few comments on this site indicating that it is usually quite the process to get your insurance to help out but I was wondering if anyone could give me specific actions that would help this happen. Is it most effective to get a written statement from a doctor that explains the need for continual use of Visbiome? Does it help to present peer-reviewed studies that show the effectiveness of these probiotics for the ileal pouch directly to the insurance company? I have had one phone call with my insurance company and they don't seem like they are very willing to budge.

If anyone has any advice as it relates to Immodium/loperamide as well because that is very expensive to use everyday as well, so ideally I would love it if I could get insurance to help out with that as well. 

Thank you in advance for any responses!

Original Post

JPOUCHER21, I’ve previously posted in detail about my year-long successful process of getting my insurer to cover VSL #3 DS. I included the text of the ultimately successful, annotated letter that I ghost-wrote for my gastroenterologist, and a link to the detailed policy that my insurer created regarding when they would cover it. You should be able to find these with a careful “Advanced Search” here, but send me a private note if you still can’t find the posts. After you exhaust your formal, written appeals with your insurer you have recourse with your state’s Department of Insurance. If you’re still in Colorado that would be at https://www.colorado.gov/pacif...a/health-insurance-0 

Make very sure to appeal on the basis of medical necessity rather than a contractual review. You don’t have a chance of winning in an argument about a contractual exclusion.

Although Visbiome is the original, well-studied formula, I have elected not to try to have the complicated conversation with my insurer about that. Instead I just use VSL #3 DS, which is the name of the product in all of those studies.

If you don’t already have chronic pouchitis then this will be an uphill climb, I think. Treating a serious condition is one thing, but trying to prevent or delay a condition you may never get is less compelling. Good luck!

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