Breast pump and insurance question

Casperdy · December 2011

I am trying to figure out if my insurance covers a breast pump and cannot find a clear answer anywhere. Maybe someone can help? We have Anthem Healthkeepers (the HMO).

There is nothing in our written policy, nothing online, and nothing spelled out in the paperwork from HR. DH talked with HR and they weren't sure and called Anthem. The person from Anthem was not very convincing and said "I don't think so BUT if you signed up for the Future Moms program then you will get a $100 gift card to Walmart that you can use on a breast pump."

That just seems like a strange answer to me. DH said the woman came across as unsure and couldn't point to anything specific in the policy, but I don't know who to call and ask next.

Anyone have any tips? Thoughts?

waltzingmatilda13 · December 2011

Try calling Anthem back and speak with someone else or keep asking for people until someone gives you an answer. My insurance had a very clear cut answer and it was no. Someone at your insurance company should know the answer or know how to find it.

greengirl0909 · December 2011

You should call and talk to someone yourself. A lot of companies do if baby is born with a condition that makes he/she unable to breastfeed such as cleft palate or premature.

On a side note, if you have a flexible spending account you can use those funds for breastfeeding supplies. Likewise, if you qualify for a medical deduction on your taxes you can use breastfeeding supplies for that also. Not as nice as insurance covering your pump, but something!

GuppyAmy · December 2011

Look under your DME (Durable medical equipment) part of the policy. Also I signed up for the future mom's program and I was assigned a "nurse case manager" to oversee my case, she is who I am going to ask about my insurance's policy, maybe signing up for the future mom's program will give you the answers you need.

Casperdy · December 2011

GuppyAmy:
Look under your DME (Durable medical equipment) part of the policy. Also I signed up for the future mom's program and I was assigned a "nurse case manager" to oversee my case, she is who I am going to ask about my insurance's policy, maybe signing up for the future mom's program will give you the answers you need.

I did sign up for Future Moms but it didn't occur to me to call them and ask. Thanks!

lawright · December 2011

I looked up Anthem's policy for their Lumenos HSA plan. There are actually (if you look hard enough) policy guidelines for providers regarding various health care requirements/techniques/etc. You go to the provider website, find your state, and then look for something that says "coverage" and/or "UM guidelines." For Virginia, you probably want to flip through: https://www.anthem.com/wps/portal/ahpprovider?content_path=provider/va/f1/s1/t1/pw_b147992.htm&state=va&label=Coverage & Clinical UM Guidelines, and Pre-Certification Requirements

Breast pumps are probably under "durable medical equipment" rather than their own category. In the case of Ohio's UM guideline (where I am), you have to have the Dr document that it's medically necessary and that the pump rented/purchased is the least expensive option to meet your medical need.

psychgirl33 · December 2011

My insurance covers it under Durable Medical Equipment. I hope you figure it out and I hope it's covered!

bingham101 · December 2011

The answer is probably NO unless you get a perscription for one. Call them up yourself. And sign up for the future mom program. Its super easy all you do is answer like 3 surveys that are very easy. Basically they just want to make sure you are getting prenatal care and they give you some other resources, then at the end you get a gift card.

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Breast pump and insurance question

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