Are breast pumps going to be reimbursed by insurance
ldrosophila
Posts: 7,512 Member
Does anyone know if you can get your breast pumped reimbursed by insurance now, or is that not going to take effect until 2014 (if at all)?
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It went into effect at the beginning of 2013, but there are plenty of rules around it. For one, the Act didn't specify what kind of pump so some cover hospital grade rentals and others cover only a handpump. You also have to go through the DME supplier that contracts through your insurance company, so you have to get the brand they cover - you may have a preference for Medela but that might not be what they offer. It's possible that you could buy a pump you like at Target (or wherever) and submit for reimbursement, but that is going to depend on your insurance company and type of insurance plan - I really doubt most plans will do this.
I believe prior authorization is also required, although I don't believe you have to have a medical need for it (whatever that even means) you just have to have a doctor certify that your baby was born somewhat recently.
Here's some info on how different insurance companies scored when it came to providing appropriate pumps:
http://www.nbfcenter.com/NBfC_Breastfeeding-Policy-Scorecard-09.2013.pdf
http://www.bestforbabes.org/booby-traps-series-grade-insurer-get-new-breastfeeding-scorecard0 -
I'd suggest calling your insurance company and checking on your specific policy. According to the web site for my insurer (Blue Cross Blue Shield HMO) they cover only a manual pump (which I was told is the bare minimum in coverage, and these run about $20 at Target). But when I called they said they cover anything my doctor says I need. That can include long term rental and supplies for a hospital grade pump, or a single or double electric to own, or a manual if that's what I want.
My insurance will NOT reimburse if I buy it, though. It has to come from a medical supply store or a breast pump specialty store.
An acquaintance has the same insurance as me (also an HMO) and they only cover the manual, so I think it depends on the type of policy our employers have picked.
Call, as it seems to vary significantly.0 -
I also think that went into effect in 2013..
I would call your insurance company and ask them what's covered and what isn't -- my doctor gave me a "gift certificate" for a local specialty store that fully covers the cost of a Medela Pump In Style Advanced (electric and double).
dandelyon - GREAT links; thanks for sharing!! (:0 -
Definitely call your insurance because what they cover is up to them. They have to cover a pump but what pump they cover and how they cover it - rental v purchase - is up to them. My insurance covered a double electric but I had to go through a specific company - if I had bought my own even from this company I would not have been reimbursed.0
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Yes, call your insurance company because they are all covering it differently. My insurance only gives you a manual pump unless the baby has issues latching or you can't breastfeed for any other reason. Then they will cover an electric pump. But, you won't know this until after birth. I'm exclusively pumping, so a manual was out of the question. I bought one using my Flex Spending Plan.0
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Just an update for those of you utilizing insurance to obtain a breast pump: Start early! It seems that even though it is definitely covered, insurance companies and medical equipment suppliers are still working out some of the kinks. It took two weeks and a dozen phone calls for me to get my pump ordered. But it was well worth it, as I got what seems to be a very nice pump at no cost to me. (I did choose to pay an upgrade fee for the bag/cooler/extra supplies just so I have it.)0
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Just an update for those of you utilizing insurance to obtain a breast pump: Start early! It seems that even though it is definitely covered, insurance companies and medical equipment suppliers are still working out some of the kinks. It took two weeks and a dozen phone calls for me to get my pump ordered. But it was well worth it, as I got what seems to be a very nice pump at no cost to me. (I did choose to pay an upgrade fee for the bag/cooler/extra supplies just so I have it.)
ty for the advice0 -
I called my insurance company and asked. They gave me a list of medical equipment dealers they dealt with. Said to call them and they would mail it to me at no charge.0
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I was happily surprised to find out that my insurance covers at 100% using an in-network DME. Now I am just trying to find out if any of them offer a Hygeia, as that is my first choice
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From what I have seen, they are not reimbursed. My insurance covers a double electric but only if I go through a medical supply. If it's purchased retail then you're just out of luck. Mine also covers the cost of a rental from the hospital until it arrives from the supply company!0
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If your insurance company is confused when you call them, make sure to remind them that breast pumps fall under durable medical supplies in most cases and that is where they will have to look up your coverage.0
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From what I have seen, they are not reimbursed. My insurance covers a double electric but only if I go through a medical supply. If it's purchased retail then you're just out of luck. Mine also covers the cost of a rental from the hospital until it arrives from the supply company!
Oh glad you bumped this so I could give an update.
My insurance company gave me the number for a medical supplies warehouse. I called the number and was put into the system, then I had to get a prescription from my OB for the pump, two days later they mailed me a brand new Ameda electric pump. All of the billing is handled with the medical supply company and the insurance company.
Worked great...thank you all for the advice.0 -
I have gestational diabetes so I am going through the hospital's medical supply company to get my lancets, strips, etc. They gave me a form about the pumps being reimbursed if you order them through them as well.0
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I am so bumping this since I'm not there yet but will be. Good advice and I would've never known it was covered otherwise. Thanks for the info!0
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I have put money in an FSA account for the last few years. When I was pregnant with my son, I bought the pump and was able to use that money. I kept the pump, so this time I might use some of my money to buy extra parts, tubes, etc. I also just found out that nursing pads are a reimbursable expense. I spent a small fortune on them last time - so I'm excited for this!0
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I had to go to a medical supply store, as well, to get mine. It was 100% covered with a little coupon thing I got from my OB. Brand new, Enjoye double electric pump with all the frills for free! I've used a ton of different pumps in the past and this one surpasses them all - I'm very, very happy!0
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I have put money in an FSA account for the last few years. When I was pregnant with my son, I bought the pump and was able to use that money. I kept the pump, so this time I might use some of my money to buy extra parts, tubes, etc. I also just found out that nursing pads are a reimbursable expense. I spent a small fortune on them last time - so I'm excited for this!
oh great to know about the pads just bought some from walmart0
