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February 2013 Moms
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Breast pump frustration

carriesu2003carriesu2003 member
in February 2013 Moms

Hi,

So I read several articles that state under the affordable care act breast pumps must now be covered by insurance companies.  I have GHI and was just told that this is only if the baby is in the nicu or has some other problem where a pump is deemed "medically necessary".  I have done tons of research online and it seems that everyone's insurance has a different response.  So, I don't get it.  Does the law say they have to cover it or not?  My insurance company read me the "provisions" which I do not trust at all to be the actual provisions of the health care law.  Anyone who works in the insurance industry or health care field who can shed some light on what is going on?

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Re: Breast pump frustration

  • Jaci85Jaci85
    mine was so lame and ended up telling me that since my plan was a grand fathered plan I couldn't get one Sad so I had to buy one...ugh
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  • Puck1182Puck1182 member
    Find out if you plan is grandfathered.  If they don't make significant changes to your coverage/premium/copays, they don't have to institute these changes until 2014.  I'm in the same boat, so I'll be paying out of pocket for my pump as well. Sad


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  • fitzgirl17fitzgirl17 member
    Is that Group Health Insurance?  I had them last year and was told only a rental would be paid/covered in full.  Could your medical provider say you have inverted nipples or something and get a doctors note that way?
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  • k8917k8917

    I don't know for sure, but from other things I've read about this, simply going back to work after having the baby is cause for a 'medical necessity' and your doctor should be able to document that for you.

     

    I've heard that many companies won't follow through until after the baby is born, though.

     Good luck! 

    IAmPregnant Ticker
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  • Puck1182Puck1182 member
    imagek8917:

    I don't know for sure, but from other things I've read about this, simply going back to work after having the baby is cause for a 'medical necessity' and your doctor should be able to document that for you.

     

    I've heard that many companies won't follow through until after the baby is born, though.

     Good luck! 

    Ooh, good point. Hmm... now I'm glad I hadn't ordered a pump yet. Going to call my insurance company this afternoon and see if returning to work part-time after 6 weeks qualifies as "medically necessary." Fingers crossed!!


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  • tamarar5tamarar5 member

    My insurance company doesn't cover them period, regardless of the reasons.  Check out your local WIC (Women, Infants, and Children) program and see if they have one you can rent or borrow.  That is how I got mine!

    When I was nursing DD#1 they randomly asked me if I needed a breast pump, and I wound up getting to borrow a really amazing double model.  They told me to keep it as long as I was still bfing, and return it when I had weaned and had dried up.  When I went to turn it back in, they told me that they had just gotten a grant to buy all new machines, so I got to KEEP it permanently.  It was awesome.

                    We're Going to be a Family of 5!

    Lilypie - (PaHE) Lilypie - (4noI)

                                   Lilypie - (2q9u)


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  • onlymegganonlymeggan
    I had to get a script from my Dr for it, find a durable medical equipment supplier, have them get authorization from my insurance, and it's covered 100%.  It took me over 2 mos of phone calls and leg work to finally get it figured out but I'm glad I did.  When we leave the hospital with our new LO my DH can run into the place and grab my pump since I've already done all the paperwork.  Most insurances do require a script, a DME, and having the baby first.  Some will process the claim within 30 days of having the baby but I have United Healthcare and they won't approve until the baby has been born.
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  • ShabbyGeekShabbyGeek member

    I have a different insurance company but it literally took me 15 phone calls over a 4 month period to finally get the same answer twice... so I would call back and talk to someone else because no one really knew and they were just giving me random answers.  Finally I found out my pump is covered at 100%- it should be here next week.  So call back and try someone new!

     Also, my OB gave me a prescription (even though I don't need one for my pump) and she stated it was medically necessary... so I would ask your OB if they can write that on your RX.   

    Baby #1 Due 2/21/13!
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  • BunnyBuniBunnyBuni member

    You are required by law to get one for free if:

    1) your plan is not "grandfathered"

    2) you started a new plan on or after august 1, 2012

    3) you renewed your current on or after august 1, 2012

     

    BCBS gave me such a runaround, you wouldn't believe it. They denied me five times before I finally got mine. You have to be persistent and remind them that they aren't above the law and you won't hesitate to start a class action lawsuit. 

    Lilypie Maternity tickers
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  • jakesgirl2jakesgirl2
    Also- if your employer is "self funded" they have exemptions too- besides possibly being grandfathered.  Also it doesn't go into effect until the first renewal after 8/1/12 so if your plan isn't grandfathered or self funded and renews let's say in June- they don't have cover it til them
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  • ThenCaliSaysThenCaliSays member
    If you have some time I would hop on to Hygeia's facebook.  They have a lot of resources regarding ACA and have been really going the extra mile for mom's to get pumps, even if you don't want one of their pumps.  my issue is I specifically want a Hygeia pump and my insurance is playing dumb about pretty much everything.  (well it became obvious they are not playing dumb, but are actually pretty stupid).  it takes perisistance, do not give up! 
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  • allisonbesseallisonbesse member
    It's frustrating, but I was also told in a breastfeeding class that all breastfeeding supplies and equipment are tax deductible, so that's at least something if you end up having to buy or rent a pump.
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  • tilsonctilsonc member
    imagecarriesu2003:

    Hi,

    So I read several articles that state under the affordable care act breast pumps must now be covered by insurance companies.  I have GHI and was just told that this is only if the baby is in the nicu or has some other problem where a pump is deemed "medically necessary".  I have done tons of research online and it seems that everyone's insurance has a different response.  So, I don't get it.  Does the law say they have to cover it or not?  My insurance company read me the "provisions" which I do not trust at all to be the actual provisions of the health care law.  Anyone who works in the insurance industry or health care field who can shed some light on what is going on?

    When does your healthcare plan start every year? Mine started in January so I was eligible. My husband?s company starts their new policy in July. I heard the new policy is what kicks in the new healthcare reform. I have United and they didn't cover the pump until Jan 1st. Hope that helps!
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