XP: Breast pump coverage / Insurance

Excitedtostart

I thought all insurance policies had to have some coverage for breast pumps after the health care reform. I called my insurance company to see what they covered and they said I had no coverage - that in the last round of union negotiations that was shelved. 

Anyone have any insight on this? I'm trying to find a government website that lists the mandate and everything it entails, but I apparently suck at researching. I swear I used to be able to do stuff like this. 

ShopperKristi

A lot of plans are grandfathered in which means if your employer didn't make any significant changes to the existing plan they are exempt from the new rules - pretty sucky if you ask me.  What a huge loophole!

DandT1206

where are you from? what insurance?  GHI in NYC won't cover it until July when the city's plan renews (whatever that means).... so annoying!

s0ulchicken

I am unsure about any negotiations being shelved, etc. but I know that most insurance companies are not required to add on the coverage until your plan renews. Not necessarily open enrollment, but when your coverage itself actually renews. For me, that would be April. What I did learn though, was that because my girls were born early and required a stay in the NICU, my insurance covered my hospital grade pump rental 100, and after their discharge the rented it to me at an 80 discount.

lynn0926

I am unsure about the research on it.  But, is it still not covered even if your doctor wrote a prescription with an excuse like latching issues or something?  With my coverage I get a 3 month hospital rental and if I need a pump after that 3 months then I need a prescription for coverage and it will be covered at 90% for a purchase of a pump from a list of providers that changes daily.  Maybe they are not telling you about the need for a prescription.  Insurance co. suck!

ShopperKristi

Mine didn't cover it with a prescription, NICU babies, or after renewal because of the grandfathered status.  They generously offered to cover 80% of a manual pump...efffff that!

radiant05

That surprises me. When I called my insurance it said breastfeeding is now considered preventative care and covered at 100%. I wouldn't need a prescription either.I would just need to go to a certain supplier to purchase.

 

Here's the link to a gov't website and some excerpts.

https://www.healthcare.gov/news/factsheets/2011/08/womensprevention08012011a.html

Additional women?s preventive services that will be covered without cost-sharing requirements include:

Breastfeeding support, supplies, and counseling: Pregnant and postpartum women will have access to comprehensive lactation support and counseling from trained providers, as well as breastfeeding equipment. Breastfeeding is one of the most effective preventive measures mothers can take to protect their health and that of their children. One of the barriers for breastfeeding is the cost of purchasing or renting breast pumps and nursing related supplies.

 

22 Covered Preventive Services for Women, Including Pregnant Women

The eight new prevention-related health services marked with an asterisk ( * ) must be covered with no cost-sharing in plan years starting on or after August 1, 2012.

6. Breastfeeding comprehensive support and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women*

ShopperKristi

Yeah I was shocked (and angry) when I found out about that clause too because I fully expected my pump to be covered as on January 1st when our plan renewed.  Here is a link to more info on grandfathered plans if you think that might be what your union has

https://www.healthcare.gov/law/features/rights/grandfathered-plans/index.html

Your company can CHOOSE to comply or add on these benefits but are not required by the law to do so.  Sounds like that is what happened with your union.  Either way, if you are planning to nurse and/or pump I strongly recommend a hospital grade pump and perhaps plan on renting one out of pocket.  Most rental companies will give a discount to those paying out of pocket (ex. mine was around $50/month instead of $90 that they would have charged insurance)

WeAreSmalls

If your union contract was signed prior to the healthcare reform law going into effect, then the union contract most likely supercedes the law. I know this was the case with federal mental health parity regulations (which is different from healthcare reform).