Breast pumps and insurance

kat81

Back when we had DS, insurance didn't cover breast pumps and there was no ACA. When we had DD, the first pump was working great so I didn't bother to try to get a new one. However, it was SERIOUSLY lagging at the very end of our nursing experience and I know we need a new one for #3. Anyone have tips to go about doing this? I've heard conflicting things about going through the insurance company, the employer, the OB/midwife, the pump supplier, etc. 

If it helps, we have Keystone Health Plan East HMO. It is part of independence blue cross. Their website completely sucks. I can ask HR or call the number and speak to someone and will probably do those things, but I welcome your advice / information as well. 

The pump tat I had was a medela freestyle and I completely loved it. It was so portable, convenient to clean, easy to use, etc. I've heard of people finding they didn't get huge amounts of milk from it but I never had that problem. I would love to go with this pump again but I expect it's not likely to be covered. I also just saw medela has a new pump called the "Sonata." If anyone knows anything about this pump let me know! It seems fancier than the freestyle and cheaper, but still more portable than the pump in style. 

erinh2005

I wish I had a better memory of when I went through this in my first pregnancy. I have a generalized memory of it being a nightmare of a process though. Something about having to go through a medical supplier to purchase which was basically a list of 900 business names and numbers and calling sooo many because of no web presence and getting the same response that they don't carry pumps. So I would ask if they knew of anywhere that did and finally got somewhere doing that. I'm just hoping mine holds up for this baby (I think we have then same one) so I don't have to figure it all out again... sry couldn't be more helpful but at least you're planning ahead and still have plenty of time to make calls lol.

NotAPlaya-JustCrushAlot

With DD, my insurance would only cover a crappy playtex. I remember that they gave me 2 names of companies that provide pumps but it was the same crappy options at both. This time around, my new insurance covers the better pumps. I had a Medela PISA last time. This time I'm going to try the Spectra. Ive heard good things about it. 

pshaortao

We just called the number on our insurance card and they said when DD was born, we could call to confirm her birth etc and they would send one asap. I think we got it within a week of her birth. I know some insurance provide different choices for pump. Mine only gave us one choice (an Ameda?)

inomniaparatus2

I just called my insurance company the other day asking about this. There are many different policies but mine gave me a medical supply store and said that I can go any time within 30 days of my due date and pick one out. They cover all of the pumps and the store just bills the insurance. My friend had her babe two years ago and she just had to call the insurance company within 30 days of her due date and they sent her one in the mail. I would suggest calling your insurance. They are knowledgeable and will tell you want to do, where to go and what is covered. 

kat81

SWE2 said:

... I would suggest calling your insurance. They are knowledgeable and will tell you want to do, where to go and what is covered. 

I'm LOLing at "they are knowledgeable" as the people at my insurance have been anything BUT in the past 2 years I've had this insurance. But I'm hoping they will be on this issue, at least. I'm not a cry-er, but I have been in tears or close to tears on several occasions when talking to my insurance people...which is to say the past 2 years I've probably cried like 6 times, and 3 were due to these insurance calls.

vrj0522

When I had DS breastpumps were not covered but they were when I had DD. I think I was eligible for a rental, which I'm not sure why sometimes they cover rentals and other times they cover the purchase. I know that they told me that even though mine was a rental after 30 days it would become mine because why would they want an used breast pump back. Anyway, my insurance company was useless in helping me find a provider that rented them. They kept giving me lists of providers and they either didn't carry breastpumps or they didn't rent them; and then my hospital didn't bill the insurance so I couldn't go through them either.

Anyway after tons of calls and research online, I came across Byram Healthcare and they did provide exactly what I needed and worked with my carrier. It was a super simple process. So my advice is to call your insurance company first, find out what your coverage is and hopefully they are helpful in getting you a pump but if not, then try Byram. I know they work with pretty much every company. 

chickyclg

I got a Medela PISA through my insurance last time and it worked well.  I called the insurance and they gave me a list of medical supply companies I could order through, and when you went to those companies websites you put in your insurance information and it gave a list of pump options.  A lot of times the insurance won't approve the pump until your last 30 days, I had my OB fill out a form since we were anticipating a preterm birth to get the insurance to push it through.

I really want to try the Spectra 2 if it's still available, if it's not I will get another PISA.

mdlorenz

I've heard really good things about Spectra as well, @NotAPlaya-JustCrushAlot - I used a PISA with DD but will try to get a Spectra this time around. 

@kat81 Right there with you about calling insurance. And crying. Ugh. Hoping things go more smoothly or you don't have to interact with them very much to make everything happen. 

@vrj0522 Agree about trying Byram if insurance is absolutely no help. 

WombThereItIs

The inevitable Tricare question:

has anyone played this game yet? My son was born Nov '14 so I just barely missed the start of them covering these. I have a PISA that I'll probbaly keep at home as a backup but I want an upgrade for work this year. I was hearing rumors the new Sonata might not count as a regular retail pump with Tricare though. 

mcvgal

I have BCBS and the provided Ameda only but I had the option of a single our a double pump, they also provided storage bags every 90 days. I just had to call and reorder them. With DS2 the website said to call about 30 days before his due date to order it. I called at about 60 days before to get more information, and they went ahead and sent it out at that time. So I actually received it before he was born.

bacorrea

@WombThereItIs ha I came in here hoping that someone with Tricare would know. From what I have read we can buy whatever and they send a reimbursement check or we can buy from place they approved and not pay anything up front? DD is April '14 so this is new for me too. 

Maybe @h&pmomma knows? Are there any other Tricare people on here? Sorry if I'm forgetting someone! 

hp_momma

WombThereItIs said:

The inevitable Tricare question:

has anyone played this game yet? My son was born Nov '14 so I just barely missed the start of them covering these. I have a PISA that I'll probbaly keep at home as a backup but I want an upgrade for work this year. I was hearing rumors the new Sonata might not count as a regular retail pump with Tricare though. 

I was waiting for the Tricare question

DD1 was 2011 and DD2 was 2014 so I've never done the breastpump through Tricare either, but super excited it's available finally! 

From fellow spouses, I know the PISA and Spectra are covered. But I haven't heard anything regarding the Sonata. And we all know how calling Tricare directly for advice goes. I do know that you can upgrade and pay the difference though! Not sure if that counts with different pumps that might not be covered at all. A neighbor got the PISA but wanted the battery pack and carrying bag so she paid the difference. 

Im going to try the Spectra this time as I've heard good things about it. I have a PISA already so getting the same one seems pointless. 

I haven't got into all the details for timing to request the pump, any Tricare ladies know that? I figured I would bring it up at an appointment in the next month or two. 

psherman42wwsa

Last time I asked my midwife for a script for the pump a couple weeks before my due date so I could have everything ready when baby arrived and I will do the same again this time. They were trying to wait until I was in the hospital after delivery to give me the script but that wasn't going to work for me. I already called my insurance and they allow you to get a new pump with each delivery. I'm pretty excited to have 2 pumps so I can leave one at work. I have a medella freestyle and I plan to get another one.

march2008

I have BCBS Federal and they only cover either electric or manual Ameda brand pumps. There is a phone number to call to order. I've been reading reviews of the Ameda electric and they aren't great. With DD1, I had a Medela Freestyle and it was great. It's 6 years old now, so it probably won't work well anymore and I may end up replacing it out of pocket with another Freestyle or PISA.

BeachMommy2B

I went through insurance with DD in 2013 and got a Medela PISA for free, I worked for a hospital at the time so I had to drive to the lactation office about an hour away but walked away with it in hand. I have since gotten rid of this pump because I thought we were done with babies.

This time I work for a different company and have United Heatlhcare they will cover a pump but I have to order it from one of 3 Medical Equipment companies all three carry basically any pump you would need, they are just the pump/parts no bag or extras you might need if you are pumping at work. I have to wait until 30 days of my due date. So i'm going to be doing that and keeping that pump as my back up. 

I actually recently purchased a Medela PISA from a lady in a local mom's swip swap group. I paid $110 for the pump, bag, cooler, etc and 10 Medela Bottles. The lady had only used it a few times because her daughter refused the bottle and she was a SAHM so pumping wasn't necessary. I'm just going to get new tubing and steralize all the parts/bottles.

mcvgal

@march2008 I have BCBS Federal as well, I loved my Ameda electric pump last time. Even if you still get your own pump, I highly recommend the storage bags. I had no problems with the bags opening and although it was only 150 bags every 90 days, It really helped on not having to spend too much on additional storage bags.

L1C4gal

Thank you all for the great information and advice!

One of my friends who is also pregnant is trying to get her pump early because she's afraid of what might happen with the new administration. Is anyone else worried about this? I'm a FTM without a strong understanding of insurance (so sorry if this is a silly question), but Google tells me that breast pump coverage is an ACA benefit so I'm wondering if it may be at risk.

chickyclg

@L1C4gal, Meh, I figure it's not going to change by May (depending on your insurance year).  

My my thoughts are ACA has brought some great things that I don't see being totally eliminated like coverage for pre existing conditions, extended parents insurance coverage until 25, and the breast pump isn't bad either.  I don't see all of those being totally eliminated since there are a lot of people on the right that say those are good things about ACA.

ShadeofGreen816

@L1C4gal I am by no means an expert so take what I say with a grain of salt. My understanding is that because of the fact that most insurances do their plans on an annual basis, even if the ACA is repealed, your plan would remain in place for the rest of the year. Often (in my experience) that is Jan-Dec, but may be different. We are unlikely to be affected by any major changes. Also,my rudimentary understanding is that the main things (many) conservatives take issue with do not include even things like covered birth control, breast pumps, etc. I have heard more issues with the lack of inter-state competition and the mandate vs tax fine situation. 
That being said, it won't hurt to include a provision for pump cost in your "medical costs" equation if that's an option for you. 

chickyclg

@ShadeofGreen816 your words are so much better than mine 

ShadeofGreen816

@chickyclg it's because today is my homework day and I am avoiding it like the plague! 

L1C4gal

Thank you, @ShadeofGreen816 and @chickyclg! Great points.

march2008

@mcvgal - I may get the Ameda electric and try it out since it's covered and all, but I am just a little worried about it because of the Amazon reviews being hit or miss. Thank you for the tip about the bags!

WombThereItIs

@h&pmomma I was reading up on the Tricare website and fact checking with some experiences other moms documented online and it sounds like you need to get a prescription for a pump through your provider (I see my PCM but your midwife or OB or whoever is probably more normal). It definitely doesn't have to be after the birth, you can buy and submit for reimbursement whenever it seems, it is just one pump per "birth event" and you need the RX when you submit your claim. 

bacorrea

@h&pmomma are those the only two they allow? I've never heard of either. 

hp_momma

@bacorrea The PISA is the Medela which is probably the more common name you've heard. I think they offer more but the Medela and Spectra seem to be the most highly sought after and I've heard really good things about the Spectra from moms who have previously used the Medela. I had absolutely no issues with my Medela, but since I already have that one (and it still works) I'd like to try something new this time. I tried the find the list they approve online but it seems like there isn't one, Tricare just approves the claim (if you purchase yourself and then submit) or looks like you can go through the hospital to get it. No surprise Tricare website is unhelpful and says to call a representative lol. 

NotAPlaya-JustCrushAlot

For moms worried about not receiving the pump until 30 days prior to birth, you likely won't need it right away.  If you do have a situation in which you need a pump (NICU stay, early birth, exclusive pumping etc.), they'll have pumps at the hospital and/or you could rent one.  I didn't start pumping until 8 weeks after DD was born and that was to build a supply for when I returned to work at 12 weeks.  I'll probably start a little earlier this time just to get in the groove, but likely won't start immediately after birth.

lnds32

I am a military spouse and also have Tricare. When I had my son in 2015 I went through a company called Aeroflow. I called them and gave them my benefits number and faxed a script for a pump from my OB. They have a list of approved pumps on their site. The sent me the pump I chose one week before my due date! It was super easy and I plan on going through them again! I didn't pay anything upfront for reimbursement. Tricare covered it at 100%!

hp_momma

@lnds32 So glad you've been through the whole process and it was easy! How far in advance did you place your order? Like @NotAPlaya-JustCrushAlot said, I'm not worried at all about not having my pump right away I just am an obsessive planner! 

lnds32

I actually called them today. They said they would fax a RX request for the breastpump to my OB and would call me once they received it to place my order. So you can call whenever just have the name of your OB, their phone number and your dependent ID available! 

kat81

L1C4gal said:

Thank you all for the great information and advice!

One of my friends who is also pregnant is trying to get her pump early because she's afraid of what might happen with the new administration. Is anyone else worried about this? I'm a FTM without a strong understanding of insurance (so sorry if this is a silly question), but Google tells me that breast pump coverage is an ACA benefit so I'm wondering if it may be at risk.

Honestly this is why I posted this question in the first place. The main reason I'm thinking about this now is because of my fear of the new administration.

lilmisscrafty-2

@kat81 I also had the same concern as you. If ACA is repealed then how soon would that effect coverage and the availability of pumps? I submitted an app with edgepark.com on Jan1. Entered my insurance info, hospital, and doctors' info. They contact your doctor for a prescription. I just got a voicemail and email that my pump is being shipped overnight and included a tracking number. I'm still in shock that my pump might actually be here tomorrow. Honestly it all seems too good to be true. 

Oh, and I went with the Lansinoh because I was familiar with the name. They had several options. Madela was one but not sure if it's the one you want.

nda_roxybabe

I have UHC Choice and can go to a few different medical supply places.
My options are:
Medela, PISA (I think I'm going to go with this one?)
Ameda, Purely Yours Ultra
Freemie, Hans Free
Spectra, S2 ( I feel like Spectra is the other one I hear good things about)
Hygeia, Enjoye
Lansinoh, Signature Pro

Thoughts on all those, what I should pick??

I just order 30 days before my due date. I am going to try to do a bit sooner though.

vrj0522

@nda_roxybabe - I would pick the Medela or Ameda. Both are of the highest quality. 

LeilaD123

Mine was really easy to get in 2015. My doctor gave me a form with the suppliers. I filled out the request online and I had it before delivery. I was surprised how easy it was. 

mdlorenz

@nda_roxybabe I'd go with Spectra, then Medela or Hygeia (last one is actually really nice since it's a "closed" system and the company has a recycling program (though Medela just started offering this too). 

nda_roxybabe

Hmm yes, my over supply friend highly recommends the Spectra. 

chickyclg

Everyone I know that's had the Spectra raves about it (all moms of multiples).  My PISA still works and I have a ton of parts that I've heard you can also "hack" to use with the Spectra.  

Thats the one I am gonna try this time, if I don't like it I'll rent a Medela Symphony for 2 months like last time and then move on to the PISA.  

Cubslove12

I'm torn I'm seeing rave reviews about both the PISA and the Spectra. All my friends used the PISA... Not sure what to do...

Also I started getting info for pumps etc... Is it worth the extra $100 for the bag to the $50 for the battery/cooler with the spectra?

Lastly... My friend said insurance may cover 2 pumps per baby, did anyone else have this? It would be wonderful to leave one at school and one at home. I'm already like a bag lady every day going to work.

psherman42wwsa

My insurance covers 1 pump per calendar year. There wasn't an option to get 2.

If your going to spend 100$ on a breast pump bag I would at least get a cute one like a Sarah Wells bag.

I never had a battery for my pump. It may have came in handy. I bought the car charger though and used that frequently.