ENROLL IN OUR DME PATIENT ASSISTANCE PROGRAM!

Hearts Enteral's DME Patient Assistance Program for Medical Foods and Formulas

Hearts Enteral is committed to helping eligible insured patients access the medical foods they need through our DME Patient Assistance Program. Our program is designed to reduce the financial burden on patients, making medical foods more affordable and accessible.

Hearts Enteral's DME Program is provided at no cost.  

• No Cost to Sign Up: There is absolutely no fee to enroll in the program.
• Insurance Billing: Once your contract is approved, we will handle all the ordering and billing to your insurance plan. We ensure a smooth process for patients, so you don’t have to worry about navigating insurance claims on your own.
• Direct Shipment to Home: We partner with manufacturers and wholesalers to place orders directly. Once shipped, your medical foods will be delivered right to your doorstep, eliminating the need for you to visit any warehouse or retail location.
• Affordability: Depending on your insurance plan, you may qualify for 100% coverage under our program. We work hard to ensure that patients have access to the products they need at little to no cost.
• No Warehousing: We do not store products in warehouses. All orders are sent directly from the manufacturer or our suppliers to ensure that you receive the freshest and most accurate products.

• Insurance Considerations: We are able to process claims through a variety of insurance plans, but please note that Medicare patients are not eligible for our program.
• Managed Medicaid Plans: We may consider managed Medicaid plans depending on the state of residence, ensuring access for as many eligible patients as possible.

1. Sign Up: Patients can easily sign up for the program with no cost involved.
2. Contract Approval: After your contract is approved, we will work with your insurance provider to process your claims and arrange your orders.
3. Order Fulfillment: Medical foods will be ordered directly from the manufacturer or our trusted wholesalers.
4. Shipping: Once your order is processed, it will be shipped to your home address, ensuring convenience and direct delivery.

Hearts Enteral collaborates with Compassion Works Medical, LLC Non-Profit 501c3 (our sister company) of Wayne, New Jersey, to provide these services.

If you have any questions or need more information about the program, feel free to reach out! We’re here to help you manage your healthcare needs.

The Hearts Enteral Medical Foods Assistance Program (the “Program”) is designed to provide relief to patients who require enteral formulas, medical foods, or specialty vitamins due to rare genetic diseases, inborn errors of metabolism, or other special medical conditions. This Program is designed to be a trusted supplier of medically necessary foods, helping to alleviate the financial burden of sourcing these products and billing insurance plans.

The Program is available to eligible patients who are prescribed medically necessary enteral formulas or medical foods by a licensed physician or dietician. The focus is on providing assistance to those who struggle to afford these critical foods due to financial or insurance challenges.

• Eligible Conditions: The Program primarily supports patients with rare genetic diseases, inborn errors of metabolism, and other special medical conditions that require enteral formulas, medical foods, or specialty vitamins. It is not limited to these conditions, and the Program is available to any patient with a medically necessary need for such products.
• Insurance: The Program is available to insured patients who are facing difficulty obtaining necessary coverage for their medical foods. Hearts Enteral will act as the supplier and will bill the insurance company directly.
  Note: This Program does not apply to patients with straight Medicare plans or certain Medicaid plans (depending on the state of residence).
• Physician or Dietician Recommendation: Patients must be prescribed medical foods by a licensed physician or dietician in order to participate in the Program.
• Financial Need: The Program is designed specifically for patients facing financial challenges in obtaining medically necessary formula/food.

• No Cost to Enroll: Patients can join the Program at no charge, and there are no hidden fees for participation.
• Direct Shipment: Medical foods and enteral formulas will be shipped directly to the patient’s home from the manufacturer or authorized wholesaler.
• Insurance Billing: Hearts Enteral will submit claims to the patient’s insurance company for the cost of the medical foods or formulas. This eliminates the need for the patient to find a separate DME (Durable Medical Equipment) supplier or navigate the complexities of insurance claims.
• Affordability: The goal of the Program is to ensure that patients receive the medical foods they need at an affordable cost. The Program works with insurance companies to ensure coverage, but coverage is not guaranteed and depends on the specifics of the patient’s plan.

• Medicare: Patients covered under straight Medicare plans are not eligible for the Program.
• Medicaid: Certain Medicaid plans are not eligible, depending on the specific state’s guidelines. The Program will assess eligibility based on the patient's state of residence.
• Coverage Not Guaranteed: While the Program aims to help patients receive full or partial coverage for their medical foods, coverage or benefits are not guaranteed. The approval of claims and payments is subject to the patient’s insurance provider’s policies and guidelines.

1. Sign-Up and Enrollment: Patients must complete the Program’s enrollment process, providing necessary insurance and medical information.
2. Insurance Verification: After enrollment, Hearts Enteral will verify the patient’s insurance details to determine eligibility for coverage under the Program.
3. Order Fulfillment: Once approved, medical foods will be ordered directly from the manufacturer or authorized wholesaler and shipped to the patient’s home.
4. Billing to Insurance: Hearts Enteral will bill the patient’s insurance provider for the cost of the medical foods. Patients are responsible for any applicable copays, deductibles, or expenses not covered by insurance.

• By the Patient: Patients may opt out of the Program at any time by providing written notice to Hearts Enteral.
• By Hearts Enteral: Hearts Enteral reserves the right to terminate participation in the Program if the patient provides false information, fails to meet eligibility requirements, or violates the Program’s terms and conditions.

• No Guarantee of Benefits or Payment: Any coverage information provided by the Program is not a guarantee of benefits or payment. Insurance providers will determine the coverage and payment based on their own policies and guidelines.
• Liability: Hearts Enteral is not responsible for any delays in shipping, insurance claim rejections, or any other issues arising from the insurance process or third-party suppliers.

Hearts Enteral is committed to maintaining the privacy of all patient data. Any personal and insurance information collected will be used solely for the purposes of processing Program applications, orders, and insurance claims.

If you have any questions or need further information regarding the Program, please contact us:

Hearts Enteral Support
Phone: 877-659-5540
Email: rfranco@heartsenteral.com
Website: www.heartsenteral.com

 Typically Considered a Medicine - Medical foods are often "considered" a form of medicine because they are specifically formulated to manage certain medical conditions and are prescribed by a licensed physician. 

Medical foods are intended for the dietary management of a patient who, because of a rare genetic disease, metabolic diseases, therapeutic or chronic medical needs, has a limited or impaired capacity to ingest, digest, absorb, or metabolize ordinary foodstuffs or certain nutrients, or who has other special medically determined nutrient requirements, the dietary management of which cannot be achieved by the modification of the normal diet alone.

Medical foods provide nutritional support specifically modified for the management of the unique nutrient needs that result from the specific disease or condition, as determined by medical evaluation. For additional details about how this is defined, visit the FDA website at https://www.fda.gov/food/guidance-documents-regulatory-information-topic-food-and-dietary-supplements/medical-foods-guidance-documents-regulatory-information.

Medical foods should ONLY be used under medical supervision for patients receiving active and ongoing medical care wherein the patient requires medical care on a recurring basis for, among other things, instructions on the use of the medical food.