If you haven't called your insurance yet...

this decaf life · August 2012

You should!

I finally called my health insurance company [BCBS] to find out about the breast pump issue and after a little digging the lady found out I can get one through a prescription on January 1st. It would take at least a week to get it so while we don't need to buy one we might need to find out if we can rent one for a month incase I need to pump/if she comes early.

simplein06 · August 2012

My insurance said I am eligible on jan 1, but cannot order the pump until the baby is born

mrsodonnell12 · August 2012

I am eligible anytime... even before baby is born. It covers 80% after the deductible is met, which it will be from the labor and delivery costs. I have a rolling deductible, so the last 3 months of hte year could for the next calendar year, so I can technically purchase the pump anytime after Oct 1.

So YES... check with your insurance company since ALL are different.

mrsodonnell12 · August 2012

This is the list of questions my hospitals lacatation consult told me to ask when I called:

1)What is their breast pump coverage?

2)What type of pump do they cover (get the brand and name of the pump)?-personal use or rental.

3)Do you need a prescription to obtain the pump?- if yes who can sign it? If no-do they need any type of form. If they have a form-have them send it to you.

4)Can you buy it anywhere and get reimbursed or do you have to get it at a medical supply preferred provider?

5)Can you get it before you deliver or does it have to wait until after delivery?

BLPL101 · August 2012

mrsodonnell12:
This is the list of questions my hospitals lacatation consult told me to ask when I called:

1)What is their breast pump coverage?

2)What type of pump do they cover (get the brand and name of the pump)?-personal use or rental.

3)Do you need a prescription to obtain the pump?- if yes who can sign it? If no-do they need any type of form. If they have a form-have them send it to you.

4)Can you buy it anywhere and get reimbursed or do you have to get it at a medical supply preferred provider?

5)Can you get it before you deliver or does it have to wait until after delivery?

Thanks!

this decaf life · August 2012

Those questions are really helpful! I wish I'd had them before I called! I had no idea what to ask.

Hildaw · August 2012

Thanks for the list of questions to ask mrso, that will be super helpful when I call!

brianabrad · August 2012

This just confirms that I really need to do this asap! Even if we had to rent one for a month or so it would be so worth it!

Did your insurance say if they cover it 100%, 50%, etc?

+lisamarie+ · August 2012

I havent called yet.....but I do have BCBS as well. Where are you? I know that BCBS varies from state to state (Im in NC).

brianabrad · August 2012

Hildaw:
Thanks for the list of questions to ask mrso, that will be super helpful when I call!

Yes Yes, thank you!

this decaf life · August 2012

I have it in Virginia but I have Federal which I guess is a little different too. I am going to call again in December just to make sure I'm ready & set to get the prescription on Jan.1st

+lisamarie+ · August 2012

this decaf life:
I have it in Virginia but I have Federal which I guess is a little different too. I am going to call again in December just to make sure I'm ready & set to get the prescription on Jan.1st

Oh okay. I did a quick google search and it was obvious that it depended on where you were and what you coverage was. I will call as soon as I have a quiet minute in the house, lol!

jobiann · August 2012

mrsodonnell12:
This is the list of questions my hospitals lacatation consult told me to ask when I called:

1)What is their breast pump coverage?

2)What type of pump do they cover (get the brand and name of the pump)?-personal use or rental.

3)Do you need a prescription to obtain the pump?- if yes who can sign it? If no-do they need any type of form. If they have a form-have them send it to you.

4)Can you buy it anywhere and get reimbursed or do you have to get it at a medical supply preferred provider?

5)Can you get it before you deliver or does it have to wait until after delivery?

Great questions...I'll use this list when I call my provider! Thanks!

xDanniellex · August 2012

I also was told to call back in January when the coverage changes. Since I'm not due till the end of the month it isn't stressing me to have to wait.

judygrove · August 2012

I just called. I am covered for 100% of the cost!!!! I have Blue Care Network (HMO).

mrsodonnell12 · August 2012

teds1chic:

I just called for the second time and they (BCBS) won't commit to anything. My policy renewal is in January and they said they can't tell me what the coverage will be until we renew and then proceeded to read off the existing benefits (rental of a pump covered only if baby has a condition and they can't breastfeed).

I asked the rep multiple times to tell me what the coverage will be in January and how the policy will work and she wouldn't. I don't know how to get this information. I'm due January 2nd and I am not interested in rushing around after the birth getting a pump if it's not going to be covered and I can get one now.

I hate insurance companies.

That's SO frustrating! You should ask if you can buy it in December..... my insurance company doesnt care if I buy it before or after the baby is born.

mrsodonnell12 · August 2012

PrivacyWanted:
teds1chic:

I just called for the second time and they (BCBS) won't commit to anything. My policy renewal is in January and they said they can't tell me what the coverage will be until we renew and then proceeded to read off the existing benefits (rental of a pump covered only if baby has a condition and they can't breastfeed).

I asked the rep multiple times to tell me what the coverage will be in January and how the policy will work and she wouldn't. I don't know how to get this information. I'm due January 2nd and I am not interested in rushing around after the birth getting a pump if it's not going to be covered and I can get one now.

I hate insurance companies.

I have BCBS currently and they were ridic on the phone. I suggest emailing them via the website instead, I got an immediate and helpful answer

It must really depend on who picks up your call- I have had great success with calling. I have done the email through the site, but it always takes a few days to hear back and Ilike to know immediatly!

runlong3 · August 2012

Thanks for the prompting to do this. I'm am one of the lucky ones who can't get any info until the policy renews (in Jan) since they may change things due to the new laws.

I have Highmark BCBS and I'm not sure if this is for just Pittsburgh area people or all BCBS, but he told me I could search for the medical policy E-37 and I could see what would constitute getting a breast pump covered under their current policies (this is apparently for all Highmark members, not just my specific policy which is why I'm mentioning it).

Hopefully your BCBS covers more than mine, but if you're in Pittsburgh with it here's what it states:

Section:	Durable Medical Equipment
Number:	E-37
Topic:	Breast Pumps
Effective Date:	August 1, 2012
Issued Date:	July 30, 2012
Date Last Reviewed:	05/2012

General Policy Guidelines

Indications and Limitations of Coverage

Rental of an electric breast pump (E0603, E0604) is eligible for reimbursement when one of these criteria is met:

A breast pump is covered for the period of time that a newborn is detained in the hospital after the mother is discharged. Once the newborn is discharged, the breast pump will no longer be covered.

OR
A breast pump will be covered for babies who have congenital anomalies that interfere with feeding. Rental of the breast pump will be covered for the first month after the baby is discharged from the hospital. When a breast pump is utilized for longer than this specified time, its medical necessity should be determined on an individual consideration basis. The purchase of a breast pump will be covered in cases where purchase of the device is more economical than the rental.

In lieu of an electric breast pump, purchase of a manual breast pump (E0602) is eligible for reimbursement when one of the above criteria is met.

When the above criteria are met, breast pumps meet the definition of DME and payment may be made for a breast pump according to the member's DME benefits.

Accessories are considered eligible for reimbursement when the purchased breast pump is eligible for reimbursement.

Breast pumps and accessories not qualifying for coverage in accordance with the above criteria do not meet the definition of durable medical equipment (DME). Therefore, they are not covered under the member's contract. A participating, preferred, or network provider can bill the member for the denied breast pump and accessories.

Coverage for durable medical equipment is determined according to individual or group customer benefits.

The criteria above regarding an electric breast pump (E0603), a manual breast pump (E0602) and accessories does not apply to those groups that follow the Women?s Health Federal Mandate effective August 1, 2012.

NOTE:Total payments for a rental item may not exceed its allowable purchase price, except for those items identified as life sustaining DME. For information on continuous rental of life sustaining DME, see Medical Policy Bulletin E-38, Continuous Rental of Life Sustaining Durable Medical Equipment (DME).

Description

A breast pump is a device used to extract milk from the breast of a lactating mother for infant feeding when the mother cannot be present at feeding time or when the infant is too sick or too weak to suck.

NOTE:This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records. Totally have my fingers crossed that this policy changes or at least the one through DH's work does by Jan, otherwise I'm SOL on getting any coverage on a breast pump.

runlong3 · August 2012

Oh, I forgot to add, make sure you ask if any of your childbirthing classes are covered! Ours won't be completely covered, but we will get a $65 reimbursement, which at least is something. Although they only cover birthing classes, not breastfeeding, parenting, etc.

schnena77 · August 2012

I called my insurance company - and they will not know until closer until the end of the year. My company renew period is in November - so they will know coverage then (but they are assuming it will be covered).

bstengler · August 2012

BLPL101:
mrsodonnell12:

This is the list of questions my hospitals lacatation consult told me to ask when I called:

1)What is their breast pump coverage?

2)What type of pump do they cover (get the brand and name of the pump)?-personal use or rental.

3)Do you need a prescription to obtain the pump?- if yes who can sign it? If no-do they need any type of form. If they have a form-have them send it to you.

4)Can you buy it anywhere and get reimbursed or do you have to get it at a medical supply preferred provider?

5)Can you get it before you deliver or does it have to wait until after delivery?

Thanks!

thanks for the great info!!!

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