Breast Pumps & Health Insurance

Dear Parents-to-be, YOUR BREAST PUMP MAY BE COVERED BY INSURANCE!

ucm335265Under part of the Affordable Care Act, many health insurance companies will now cover breast pumps, breast feeding supplies and support (such as lactation consultants). 

It's not a 100% assured benefit in all plans, so contact your health insurance provider to find out NOW (don't wait til after the baby comes!).

Since this is a new feature, be forewarned that you may know more than your insurance company (check out Women's Preventative Services' Required Health Care Coverage Guidelines HERE).

Here is what one person did to secure her breastpumps:

- Call your insurance company and ask them if they cover breast pump (mine actually covered the double electric pump. What they didn't cover are the accessories like the bags, etc)
- They should give you contact info of providers to call to order your pump
- You probably DO need a prescription, so you may need that from your medical provider
- They may ship you the pump at the beginning of your third trimester, so you can start this process before the baby is born.

Beware of Loopholes: Coverage is limited to pumps and products purchased through a Durable Medical Equipment provider (not Babies R Us, so check before you buy).

Lactation Consultants: Insurance companies can be sticky about who they cover (in vs. out-of-network). The Health and Human Services Department says lactation services can't be denied for reasons such as this (see New York Times' stroy "Breast-feeding Services lag Behind the Law". 

Useful Resource:

Breast Pumps: Don't Be Misled - Get the FactsBreast Pumps: Don't Be Misled - Get the Facts - from the FDA

The National Women's Law Center put together a PDF toolkit that provides information on the coverage of breastfeeding support, supplies, and counseling according to the health care laws. It also offers detailed instructions on how to call insurance companies and ways to file an appeal if your plan denies coverage. The toolkit includes draft appeal letters tailored to commonly encountered scenarios. Download it here.

Additional Reading: One academic journal published a guide for creating a model health insurance policy that covers breastfeeding and related services. This won't help you with your claim but it's useful info, especially if you find yourself educating/lobbying and need a resource to draw from.

Here's a recent story one of our PSP members about her breast pump purchasing experience: "I called my own employer-provided insurance plan and they do have a process (i.e., you need to get a doctor's prescription and purchase the breast pump at an "in-network" durable medical equipment store. So you can't just buy the pump at any store and submit the receipt expecting to get reimbursed.) Best to check with your insurance company and get detailed information. But I understand that this coverage extends to the electric, high quality pumps like Medella. Since this is new for many insurance companies, don't be surprised if you initially get a representative that doesn't know what you're talking about. Just be persistent and talk to your doctor too (mine was happy to accommodate my request and asked that I get all the right forms for them to sign to make sure the pump gets paid for properly). Hope this helps and please feel free to spread the word."

Get more breastfeeding advice here.