What makes a breast pump medically necessary?

mandeline21 · January 2010

My insurance will cover a breast pump if the doctor writes a prescription and deems it a medical necessity, but not for convenience. So, why would a pump be a medical necessity?

Worcbride · January 2010

I had low supply so if my insurance would've covered it (which they didnt) my dr would've wrote me a rx for one.

LovingMyHubby · January 2010

My dr. said one reason would be if baby was in the NICU and I was having to pump while he/she was there.

cdc1982 · January 2010

I just found this: https://www.breastpumpsdirect.com/breastpumps_covered_by_health_insurance_a/148.htm

RadicalDreamer143 · January 2010

Apparently nothing that means I was able to use my FSA last year (prior to birth) - my OB and I tried everything. So I just bought the pump, and spent the rest of my FSA on some nice polarized Oakleys for DH, contacts and polarized Versace sunglasses for me. Because ironically, they had no problem paying for those.

ckstokes · January 2010

pretty much, the prescription alone deems it medically necessary... just ask them for a prescription so your insurance will cover it and they will. Most providers will do this for you for any type of medical device if it helps you get it cheaper, etc.

RadicalDreamer143 · January 2010

ckstokes:
pretty much, the prescription alone deems it medically necessary... just ask them for a prescription so your insurance will cover it and they will. Most providers will do this for you for any type of medical device if it helps you get it cheaper, etc.

A prescription is NOT the same as a "letter of medical necessity" which some insurance companies and FSA plans requires - it even has a format and requires specific medical codes. I dealt with this for three months last year, including having my OB call the company to complain.

robinsokj · January 2010

If I go home before my babies my insurance will cover a pump

mandeline21 · January 2010

JamieS2006:
Apparently nothing that means I was able to use my FSA last year (prior to birth) - my OB and I tried everything. So I just bought the pump, and spent the rest of my FSA on some nice polarized Oakleys for DH, contacts and polarized Versace sunglasses for me. Because ironically, they had no problem paying for those.

LOL!

Thanks, ladies! I suppose I could have googled this, but it's more fun reading your responses and hearing your experiences.

RadicalDreamer143 · January 2010

mandeline21:

JamieS2006:
Apparently nothing that means I was able to use my FSA last year (prior to birth) - my OB and I tried everything. So I just bought the pump, and spent the rest of my FSA on some nice polarized Oakleys for DH, contacts and polarized Versace sunglasses for me. Because ironically, they had no problem paying for those.

LOL!

Thanks, ladies! I suppose I could have googled this, but it's more fun reading your responses and hearing your experiences.

No problem. I think I was Lenscrafters customer of the month in December, since I had about $1200 to spend in FSA, ugh. And the two pairs of sunglasses weren't even prescription. I did also get a pair of regular Versace glasses too, I forgot about those, lol.

Abc15379 · January 2010

My insurance will only cover if baby and I are seperated(I go home first, vice versa). However, my local health department has a Lactation Consultant that works with WIC to provide new moms with breast pumps. You may be able to look there and see if they can help.

JenGK · January 2010

I just check my insurance's clinical policy bulletins (I have Aetna) and it will only cover rental of a breast pump if you are discharged before the baby, and then only for the period while the baby continues to be hospitalized, or if the baby has a congential deformity that interferes with breast-feeding (cleft palate, tongue-tied, etc.).

katester72904 · January 2010

Well, if god forbid your LO needed to stay in the hospital, and you were discharged or visa versa. That is what my insurance told me.

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