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March 2012 Moms
breast pumps covered by insurance
Hi,
I read an earlier post about breast pumps being covered by insurance. I called my insurance (anthem bc of ca HMO) and they said as long as the doc wrote an RX for it, it's covered. I asked where I needed to take the RX and they said usually the hospital has a place. I called the hospital and they said they have breast pumps but they don't deal with insurance and it's up to me to sort out the claim.
Has anyone else done this before? Do i need to submit the paperwork or should it be 'filled' like a typical RX?
Any advice/personal experience would be great. Thanks!
Ailish
This discussion has been closed.
Re: breast pumps covered by insurance
I would ask your OB and if they don't know, ask the lactation consultants at the hospital. Surely one of them will have that info (or at least I hope they would!)
I actually just got off of the phone with my insurance and was told it wasn't covered because it's considered a "Comfort and Convenience" item - um...WHAT?!?
Whatevs.
If your insurance company covers it (lucky you!), they might have a preferred vendor for medical supplies (like crutches, wheelchairs and things of that nature). Call back and ask if there is a store or medical supplier you should take your Rx to once you get it from the doctor.
Mileage may vary - but we have Cigna. We got a precrip from the OBGYN and then we called Care Centrix who is Cigna's durable medical equipment provider. They did an intake (all info) and we faxed over the prescrip. A few days later we got my wife a Medela PIS tote..
We have a deductible - so it wasn't "free" - but the cost goes towards the deductible. And it was also ~$185 - which was inexpensive regardless.
It might depend on coverage. And it might depend on provider. But it's worth at least investigating.
I found out yesterday, ours is covered 80% after deductable. I had to ask my OB for a PX and then I have to bring the PX to a certain place (there are 3 places here where I live) and they give me the pump and submitt the PX just like the pharmacy.
Good luck!
Are the pumps rented or do you get to keep it after you pay deductibles/coinsurance etc?
I called my insurance about this yesterday actually. They said my doctor would need to send in an approval and then I would obtain the pump from a DME vendor/supplier. The cost will be 100% covered. I'm going to talk to my OB next week for more details on this because I don't quite understand it all... From what the insurance company said, my primary doctor would have to let me know what supplier they use so I can get the pump. It would be nice if I could have it on hand before my little one is here, but I have a feeling it might not be that simple. I'm expecting that they need to wait until I am actually nursing to write the prescription.
ETA: I really need to read all of the posts before I speak. That is great to hear that doctors are willing to write out the prescription before the baby is here!! I am totally asking for a prescription next week!
I think a lot of hospitals do rent them, but if your insurance is paying for it, I'm guessing they are buying it for you. I don't know how your insurance works, though.
Mine buys it for us (we're lucky, it's 100% covered). We just order it from the hospital when we are there to deliver. They offer a number of models, so we just have to decide which one. We are going to a breastfeeding class next week and the instructor covers the different models available for rent and purchase and she will go over the procedures to get one either with or without insurance coverage.