Health insurance and breast pumps?
elizabeth0705
member
Hey all,
So, as of August 2012, my insurance company (Aetna) is covering breast pumps 100% (without a prescription) when bought from a "durable medical equipment" (DME) supplier. The only problem is that every single time I've called them or a DME company, I've gotten a different answer regarding what exactly is covered.
Today an Aetna rep told me that they will cover either a hospital grade pump rental OR a purchase of a standard electric pump. However, after the rep asked around, she determined that a "standard" pump is only a single pump (not a double pump). During previous phone calls, the insurance reps told me that the plan doesn't specify whether it is a double or a single pump. I'm so confused! Does anyone have Aetna and know what type of pump they will be ordering?
This should not be so frustrating...
Re: Health insurance and breast pumps?
I would call Aetna back and ask (again) what type of pump is covered and ask them which DME supplier near you is in-network. They can usually give you a reference number for your call, so write that down along with the name of the person you spoke with and the date/time of your call.
Then, call the DME they provided you with and ask for the type of pump Aetna told you you qualified for. They log their calls, so if you submit a claim for something the representative told you was covered, it should be covered. You might also want to check the website and see if you can correspond via email to get it in writing.
I know you didn't ask this, but if you plan to do a good amount of pumping (especially if you're going to pump at work), you really need a double electric pump, or you're just not going to get enough milk and it's going to take you forever to pump enough. If they only cover the single, maybe consider going with the option to rent the hospital grade one at first to make sure that breastdfeeding and pumping is working out for you, then purchase one to use for when you go back to work. I pumped for over a year, and there's no way I could have done it without the double electric.
All of what she said
I also had atena they covered a medela PISA in full but it had to be from a pharmacy. They gave me a list of places to call. It took 2 hours but I found one that had them available. They sent it fed ex at no extra charge
Make sure you get the name and some sort of reference number fOr the call
Thanks, everyone.
Just to clarify, I will not be going back to an office-based job (I work from home, and will be taking at least six months off). However, I will have twins, and would like the option of pumping. I would imagine that using a single pump as opposed to a double pump would be very time consuming given how much the twins will need.
Also, I have called Aetna three times, and the first two times I was told that I could purchase ANY manual or electric pump I wanted, as long as it wasn't hospital grade, and that I had to order it through a DME supplier. I definitely qualify under the new policy change. They said the policy was so new that they didn't have a specific list of models yet, so I could pick whatever I wanted. This time when I called they told me that they would only cover a single electric pump or a manual pump purchase through a DME supplier, or a hospital grade rental (not a purchase) if the babies are in the NICU. The only reason I called them back at all was because one of the DME companies I contacted called Aetna to clarify my coverage and were told that I could only buy a single pump or manual pump through them. Ugh!
I think I am just going to call back again, and get a reference number like pps suggested. Otherwise, I will probably plan on renting if the babies end up spending any time in the NICU.
I don't have Aetna but I do work for a large, national health insurance company. My advice would be to not only get reference numbers for your calls and the rep you spoke with but ask Aetna for the HCPCS code (the medical code for dme) for the pumps you qualify for (they should give you those I think there are only a few) and use that to call the DME suppliers and see what the code is actually for. I know our company covers a NON hospital grade double electric for purchase and a hospital grade double electric for rental upon policy renewal. Also check the Health care reform website because if I recall correctly the coverage levels are mandated as to the minimum they are required to cover.
HTH
I have Aetna too, but the reps I spoke with (and got three different stories from) had me call my hospital (who I get my insurance through) and get the statement of coverage from them. From what I gathered, Aetna and my employer worked out what is covered and what isn't, so I get $300 toward any pump I want, and it can be purchased anywhere.
Maybe call your employer and see what they say about what their specific plan with Aetna covers?
My two boys are getting a surprise May 2015!
Thanks, everyone! I will take all of the advice. I am also going to see how long of a rental period I would be covered for.