Top 18 how to get breast pump through insurance

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Video How to get breast pump through insurance

Under the ACA, insurance companies must cover a breast pump and supplies at no cost to pregnant members or members who just gave birth and are breastfeeding. The challenge is that the ACA doesn’t say what kind of breast pump insurers must cover, including its price range. As a result, breast pump coverage varies widely depending on the insurance you have.

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Contact Your Insurance Company

Since there are no standard guidelines, calling your insurance company is the best way to find specific details about your coverage.

“I tell my patients to call their insurance company by their third trimester,” says Lisa Paladino, a certified nurse midwife and international board-certified lactation consultant in private practice in Staten Island, New York.

In Paladino’s experience, most insurance companies have a dedicated maternal child specialist who can explain the process and the coverage to which you’re entitled. But start by calling the Member Services phone number on the back of your insurance card.

Ask the Right Questions

Before you make the call, gather your questions. Here’s a list to help you get started, along with what you can expect the representative to say:

What types of breast pumps do you cover? Some insurance companies offer as many as nine choices, including double-electric, single-electric, battery-operated and manual models. At the other end of the spectrum, some insurance companies only offer one or two options.
Where can I get my pump? Most insurance companies require that you get your pump from an in-network provider. There are usually several options, so ask for their list. Frequently, the in-network providers are durable medical equipment (DME) suppliers that operate online, such as Yummy Mummy or Aeroflow Breast Pumps. “These vendors specialize in working with insurance companies,” says Paladino. “They know what pumps your insurance covers, they have all the forms and they know what documentation you need. And you don’t pay anything upfront. It can be a very easy process.” Your insurance company’s in-network providers may also include retail outlets such as Walmart and Target. These stores also have an online process to order your pump. Once you know which providers are in-network, pick one and go to their website. Most of these companies (including Walmart and Target) have tools on their homepages that let you select your insurance company and your state. Once you’ve entered your information, it will show you all the pumps your insurance covers.

Do I have the option to upgrade my breast pump? Some insurance companies and DME suppliers will let you upgrade to a more expensive pump if you’re willing to pay a portion of the cost. If this is an option, the website will highlight the pumps that are considered upgrades. The pumps covered at 100% will say $0.00. The upgrades will list a dollar amount that is your share of the cost if you want that pump. Whether you have this option varies by insurance companies.
Do I need a prescription? You may need a prescription and/or pre-authorization to get your pump. Ask about this policy so you’re not scrambling to get it from your midwife or obstetrician at the last minute. Even if you don’t need a prescription, the DME (or other provider) may need to verify some information with your doctor before shipping your pump. Again, this process varies by insurance companies.
Do you cover hospital-grade pumps? A hospital-grade pump is an electric pump that’s more powerful than a personal double-electric pump. “Most insurance companies do not routinely cover these pumps unless it’s a medical necessity, such as the baby was born tongue-tied or low birth weight or Mom has low milk supply,” says Paladino. In these cases, your doctor or midwife will need to provide a prescription and diagnosis code.
Will I have to pay anything toward a hospital grade breast pump? These pumps are very expensive, costing as much as $2,000. If you’re eligible, the insurance will cover a rental—not one you keep. You may have to purchase your own collection kit — which includes the tubes, valves, breast shields and bottles that you need to use the pump. You may have a deductible to meet before your coverage kicks in, as well as a co-payment. Your costs are determined by your plan’s DME coverage. The insurance representative you speak to should be able to look this information up while you’re on the phone with them.

Consider Various Breast Pumps

If your insurance company offers several options, you will need to decide what kind of pump works best for you. Here’s a brief overview.

Double-electric pumps: “Electric pumps are designed to mimic the way a baby nurses, first with quick, short pulls to create a let down and then a longer pull,” says Nicole Drury, a certified La Leche League leader in Northampton, Massachusetts. “The double-electric is the most efficient type of pump since it lets you pump both breasts at once. But some women really don’t like this setup, and feel like they’re hooked up to a machine,” she says.
Single-electric breast pumps: You can only pump one breast at a time with this style, which can take longer. But some women like having the option of pumping one breast and letting the baby nurse on the other breast at the same time.
Battery-operated breast pumps: These pumps may be ideal when you’re on the go. “If you’re traveling and don’t have guaranteed access to an electrical outlet, you could pump in the car if you had to,” says Drury. “This pump might be right for you if portability is more important than speed.”
Manual pump: “Some women love this low-tech option,” says Drury. “They’re super portable and I know a lot of moms who swear they get a lot of milk pumping manually, saying they can get really good suction and a long pull.”

How to Get Your Pump

When you can get your pump varies. Each insurance company has different guidelines as to when your breast pump can be shipped. If you don’t get it while you’re pregnant, you can get it after you give birth. But Paladino suggests getting it in your third trimester, if possible. “It’s one less thing to worry about,” she says.

Can My Insurance Company Refuse to Cover a Free Breast Pump?

If your insurance company says that your coverage doesn’t include a free breast pump, the most likely reason is your plan is considered a “grandfathered” plan. These are plans that existed before March 2010 (when the ACA was enacted) and haven’t changed substantially since then. Grandfathered plans are not obligated to comply with certain provisions of the ACA, including the coverage of preventive services at no cost.

If you’re denied a breast pump and you think your plan isn’t a grandfathered plan, you have the right to appeal. The appeals process should be clearly stated in your member handbook or on the insurance company’s website online. If you need help, contact your state’s Department of Insurance or Consumer Assistance Program.