Breast-feeding and Obamacare

lhcooper · August 2012

I haven't paid too much attention to the details of the healthcare law since I am fortunate enough to already have good health insurance. And so I did not learn until tonight when it was on the news that most insurance companies must, as of tomorrow (well -- it's midnight -- today), cover breast-feeding supplies (including breast pump rentals, don't know about purchase) and support (lactation consultants). (Also GD screening and other prenatal preventative tests. All WITHOUT copays or coinsurance. I can't wait to call my insurance tomorrow and make inquiries, especially since just a few weeks ago they said a pump rental would not be covered.

Anyway, I thought I'd post about this in case anyone else was also not paying attention to the details. This still won't help all of us, but it should make a difference for many.

Nita14701 · August 2012

I have to call my insurance companies again. I called 2 weeks ago asking about this and they said they didn't cover it unless it was "medically necessary" like if baby was still in hospital and I got sent home and needed to rent pump to send milk for baby. I also asked them about any changes with Obamacare and person I spoke to didn't know anything about it.

lhcooper · August 2012

I was told the same thing a few weeks ago also, so I too need to check, as should we all.

Adi · August 2012

Good to know! I wonder how many insurance companies will try to get out of this. (I already have a pump, so I don't need a rental, but it could save a lot of $ on supplies)

lhcooper · August 2012

I have just learned -- though I haven't called yet -- that it applies to the plan year that starts on or after today. So since my plan is calendar year, nothing would kick in until Jan. 1, if then. Of course, if I am successfully breast feeding, I would still need supplies. We will see.

solarflare · August 2012

Wow - what a great piece of information! Thanks for sharing.

teresamartini11 · August 2012

They don't have to start covering it until after your renewal date. I'm not sure if it's required but mine will cover the cost of buying a pump (medical necessity not required), but you have to buy it from a medical supply place not just any retail store.

stever · August 2012

lhcooper · August 2012

Yeah, not until policy renewal date. And they definitely don't know all the rules yet -- for example, mine said they only have codes for breast pumps, not other supplies or lactation consultants. And they also didn't have info about how one should purchase, but I assume that it will indeed have to be through a medical supplier, not Amazon or what have you. Today is the first day -- here's hoping they all can figure it out. It is gonna save the cost of a breast pump for so many of us, for sure (just not me...unless I rent for 3 months first at which point I might as well buy the $170 Ameda that I have my eye on).

dmathis10 · August 2012

I can tell you what my insurance company told me - I have been speaking with them for months now trying to get details since I am due August 7th and knew the law changed August 1st.

I have Aetna through my employer. As long as you don't have a grandfathered plan, you are covered as health care reform laws are passed (and don't have to wait until your renewal date). My employer doesn't have any grandfathered plans, so I am covered for a pump as of August 1. Be sure to clarify this with your insurance company b/c, like PP's have said, some insurance companies won't start covering until the renewal date. I do have to purchase through a durable medical equipment provider. Edgepark Medical Supplies (or their parent company RGP Incorp) is a good one to look at. They are a national mail order distributor, and I was told by Aetna that they are in network for me. Aetna also told me that Edgepark may ask for a written Rx from my doctor, but my nurse midwife already told me they could provide this if needed. I was told to order from Edgepark and they will bill my insurance company (I will end up paying 10% of the cost).

I hope this helps a little...

Animeg2+1 · August 2012

Wow! Exciting positive changes. I'll have to check with my provider too. Though, I don't know about anyone else, but I get to reset my insurance plan with any major family changes, such as having a new baby. Hopefully that will open the option if it isn't available beforehand.

itsmevkb · August 2012

lhcooper:
Yeah, not until policy renewal date. And they definitely don't know all the rules yet -- for example, mine said they only have codes for breast pumps, not other supplies or lactation consultants. And they also didn't have info about how one should purchase, but I assume that it will indeed have to be through a medical supplier, not Amazon or what have you. Today is the first day -- here's hoping they all can figure it out. It is gonna save the cost of a breast pump for so many of us, for sure (just not me...unless I rent for 3 months first at which point I might as well buy the $170 Ameda that I have my eye on).

Unfortunately, the saving on the price of a breast pump won't even begin to cover the increase in my premiums but hopefully you're one of the lucky few who doesn't see a premium increase every year.

MelleTX · August 2012

Very interesting. I am self-employed so I have a private insurance plan, not group insurance. And because of that, I get zero prenatal coverage. I am wondering if any of that will change now. Probably not since those are usually state mandates. Thanks Texas!

lhcooper · August 2012

Yeah, Melle, unfortunately it may not apply to you -- but call and check. There's always the possibility too that private insurance companies may have to start to compete with each other on this issue. I hope it can work for you in some way.

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