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Breast Pumps and Health Insurance

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

See the National Women's Law Center Guide for a helpful guide, including questions to ask your health insurance.  NOTE: mothers are entitled to a pump through the news laws, but it may not be the pump they want.  Also, some pump manufacturers are making insurance versions of pumps that some women have found to be less effective.

 

It's not 100% assured that your insurance provider will offer this, but if you are currently pregnant, this is the right time to contact your health insurance provider to find out. Don't wait until the baby is born - take it from us parents: you will be severely sleep deprived!

This coverage is still a new feature and several PSP members have reported that when calling their insurance company, they were the ones who had to educate the person answering the call. To learn more before you call, check out Women's Preventative Services' Required Health Care Coverage Guidelines HERE.

There are some loopholes to be aware of.  For example, insurance companies only extend the coverage to pumps and products purchased through a Durable Medical Equipment provider. Your "Babes R Us" store isn't one, so be aware of this when shopping around.  Check with your insurance provider to find out where is the best spot to shop.

Also, women have reported that their insurance company would not provide a lactation consultant, locally, who was in-network. Subsequently, the insurer said it would not cover an out-of-network provider. The Health and Human Services Department says lactation services can't be denied for reasons such as this. Read more about that here: http://nyti.ms/1gdRpls

Here's a recent story one of our PSP members about her recent 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 equiment 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."

 

last updated: October 2013