S/O-- Breast pump insurance coverage

Allison546 · October 2012

Wanted to S/O the breast pump thread...I know we brought this topic up about a month or so ago, but I wanted to check and see if anyone was able to get any new information about what their insurance plans will be covering.

I have BCBS, and since our annual enrollment is coming up soon, I called again to see if they had any newer info on covg for next year in light of the new healthcare laws. Unfortunately it seems like the only thing that is improving is they'll waive co-pays for breast pump rental, provided it's a "medical necessity" (ie premature baby) (their words, not mine). Otherwise all they will reimburse is $50 for a breast pump purchase, which is a joke IMO given the prices of the good electric ones (which I will need when I go back to work full-time).

Anyone get any better news from their insurance cos. on this?

jobiann · October 2012

I have BCBS also and I work for County Government. My breast pump purchase is covered up to $265 or so...I can't remember the exact number. I can get it anytime, I just need a prescription from my doctor and need to purchase it from an in-network medical equipment provider. I plan to order it later this month.

SPK926 · October 2012

I have BCBS as well but that means nothing because it's dependent on each person's plan and coverage.

I am lucky in that my insurance is covering 100% of a breast pump (for me to buy one). All I need is a prescription from my doctor (which he will gladly do) and buy the breast pump through a medical supply company. (they gave me the name of one I can choose to use)

My insurance also covers 100% of pre-nantal and delivery so we will literally pay $0.00 for my entire pregnancy, birth and hospital stay.

Again, even though we both have BCBS you can see how much our plans our different. Also, my renewal date is July 1st (unlike most people's January 1st) and since this new law didn't go into effect until August I actually missed the cutoff but it doesn't matter as they cover it 100% for me anyway and always have I guess.

spikeinc · October 2012

I have United Health Care. I was told I would be covered 100% if I purchase from an in network medical supplier. The man on the phone said I could do it right away but my maternity nurse said she thought I had to wait until January. Going to call again next week.

So far, finding a medical supplier with breast pumps has not been easy. I have found one in about 15 places I called and that was from the huge list sent to me by United healthcare of places within network.

brianabrad · October 2012

spikeinc:
I have United Health Care. I was told I would be covered 100% if I purchase from an in network medical supplier. The man on the phone said I could do it right away but my maternity nurse said she thought I had to wait until January. Going to call again next week.
So far, finding a medical supplier with breast pumps has not been easy. I have found one in about 15 places I called and that was from the huge list sent to me by United healthcare of places within network.

I have UHC as well and when I called they said they couldn't tell me exactly what my coverage would be until my plan renews on 1/1/13 but that they have seen most of them covered 100% if purchased from an in-network medical supply.

I'll for sure be calling on 1/1/13 to ask what my next step is.

For others who might have UHC, I found this information helpful.

https://broker.uhc.com/articleView-9617

bearkatjen · October 2012

I have United Health Care too, and my benefits people have told me UHc will cover up to $250, UHC has said $200, and I, along with UHC's assistance, have not found a single in-network durable medical supply company that can sell any kind of breast pump. I continue to research.

akating · October 2012

I have BCBS of Michigan. They told me that it all depends on the plan you have. I have 30$ co-payment for office visits. I also have a 4000$ deductible however all but 250$ of that is covered by EHIM (DHs company coverage). Once the deductible is met BCBS covers 80% of all medical bills including medical equipment (which is what a breast pump is considered) which means I only have to pay 20% of the cost of a breast pump. They require I get a doctors prescription and that we get it from a qualified medical equipment supplier.

bearkatjen · October 2012

akating:
I have BCBS of Michigan. They told me that it all depends on the plan you have. I have 30$ co-payment for office visits. I also have a 4000$ deductible however all but 250$ of that is covered by EHIM (DHs company coverage). Once the deductible is met BCBS covers 80% of all medical bills including medical equipment (which is what a breast pump is considered) which means I only have to pay 20% of the cost of a breast pump. They require I get a doctors prescription and that we get it from a qualified medical equipment supplier.

Your DH may need to have a talk with his benefit people, because the wording in the bill is that these services and supplies are covered without having to pay a copay or insurance deductible.

mattdk06 · October 2012

I have BCBS of Michigan. I think your doctor needs to prescribe the pump and it'll be covered under durable medical equipment.

pebbleann · October 2012

I live in MA and have Health New England insurance. Their coverage sucks. They will cover a manual pump at 0 copay if prescribed. An electric pump is only covered if the child stays in the hospital after I go home. Looks like I'll be using my Flex Spending plan.

Oriam · October 2012

When I called my insurance they really couldn't tell me anything other than when my plan renews in April 2013, that's when the breast pump coverage begins.

Chappy_jr · October 2012

I have BCBS. When I called to ask last week they said that it would only be covered if there was a major medical necessity but that it wouldn't go into effect until my coverage renews in April. At least the person on the phone was able to laugh with me when I pointed out how convenient for them that my deductible renews in January but my plan does not do so until April....

spikeinc · October 2012

For the Untied Healthcare people, here is the link to the one provider of breast pumps I have found so far that is in network. Not much info on the website but when I called she said they were Medela pumps.

https://www.byramhealthcare.com/breastpumps/index.php

Allison546 · October 2012

spikeinc:
So far, finding a medical supplier with breast pumps has not been easy. I have found one in about 15 places I called and that was from the huge list sent to me by United healthcare of places within network.

Based on these responses, I called back to make sure I was getting the right info. Turns out a different person at BCBS did tell me that in fact it will be covered 100% starting Jan 1st as long as a I get an Rx and buy it from an approved medical supplier. So that's great news and thanks to everyone!

I started calling around to a bunch of medical suppliers on the list from BCBS as well and have been striking out finding a place that carries breast pumps! I told a couple of places on the phone that with the new healthcare law, there will be increased demand for these suppliers for breast pumps, as we can no longer just buy them from retailers like BRU if we'll all be able to use insurance. So hopefully as time goes on more of these suppliers will start getting on board.

ReeceFamily · October 2012

I have Blue Shield through the state of CA, and when I called, they said they'd cover 100% of pump rental or purchase, but the order has to be placed through my doctor's office (not sure how this will work). Then again, the person I talked to on the phone was clueless about this and had to go ask her boss, so we'll see what benefit I actually get when the time comes.

this decaf life · October 2012

I have BCBS Federal and they told me I can get a breast pump for free but it had to come through their medical provider so I'd need a prescription on January 1st and it would be mailed to me about 1-2 weeks later. The woman didn't really seem 100% sure in what she was saying though so I figured I'd call them back at the end of November to get better details.

IsaiahGirl · October 2012

I talked to a lady at UHC the other night, and she had just received an updated email about how to find a pump.

It does have to be through a covered medical supplier, and the way it is completely covered is the code the supplier uses to order it - so it could technically be any pump you want as long as you find a supplier that codes it the right way.

I haven't called yet, but the rep told me to try the hospital first, and if they couldn't order one, to try these companies that I can order from, but they'll bill my insurance directly:

Genadyne

1-800-208-2025

www.genadyne.com

Apria

1-800-277-4288

lulamagoo · October 2012

We have Aetna. The cost will be covered 100% in January. At the beginning of January, my DR has to call in a prescription for the pump to a Durable Medical Supply company (Apria) for the Medela Pump In Style. They will process it with my insurance and send it to my home.

mtm0109 · October 2012

I had BCBS with my son.. and the doc wrote me a prescription for the pump and brought it to a specific med supply store.. and it was covered all but $40 is what we had to pay for a $295 Medela breast pump.

erkie · October 2012

My insurance will only pay for a manual pump.

bearkatjen · October 2012

IsaiahGirl:
I talked to a lady at UHC the other night, and she had just received an updated email about how to find a pump.
It does have to be through a covered medical supplier, and the way it is completely covered is the code the supplier uses to order it - so it could technically be any pump you want as long as you find a supplier that codes it the right way.
I haven't called yet, but the rep told me to try the hospital first, and if they couldn't order one, to try these companies that I can order from, but they'll bill my insurance directly:

Genadyne
1-800-208-2025
www.genadyne.com
Apria
1-800-277-4288

Apria is a no go. I called them last week, and they are only contracted to rent pumps, not to sell.

dlbrous · October 2012

When I called, I received information similar to the OP. I am glad to hear that others have talked to seemingly clueless insurance representatives. I was planning to call back to talk to someone else. If they are picky about the way it's coded, this makes me nervous. It makes me think I'll end up getting a bill in the end. Definitely worth a try. All the moms who have been told that theirs will be covered on January 1, I'd be interested to see what happens at that time when everyone is getting prescriptions and trying to get theirs ordered. I wonder how easily the demand for pumps will be met by these DME companies, since so few of them carry pumps.

IsaiahGirl · October 2012

bearkatjen:
IsaiahGirl:
I talked to a lady at UHC the other night, and she had just received an updated email about how to find a pump.
It does have to be through a covered medical supplier, and the way it is completely covered is the code the supplier uses to order it - so it could technically be any pump you want as long as you find a supplier that codes it the right way.
I haven't called yet, but the rep told me to try the hospital first, and if they couldn't order one, to try these companies that I can order from, but they'll bill my insurance directly:

Genadyne
1-800-208-2025
www.genadyne.com
Apria
1-800-277-4288

Apria is a no go. I called them last week, and they are only contracted to rent pumps, not to sell.

Well, I hope either the hospital or the other company works! The rep did seem positive that others (and maybe even doc offices) would start carrying them closer to January since insurance would start covering it and so many would be getting one through a medical supplier. She said to wait and see, though, because she wasn't sure. From PP, it seems it's hard to find a company that will do it.

One more thing - the rep said all the parts were covered as well - extra tubes, breast shields, and even the bottles that connect to the pump. Looks like we might be able to order a second set for free.

amieo33 · October 2012

My insurance covers the pump, but what accessories are you planning on purchasing?

Lauren238 · October 2012

I have good coverage through BCBS AL & I called about it, but the lady sounded like she had never heard of them doing it. She researched it and made calls to other customer service people and came back with the answer that they would only pay a portion of the cost ONLY to rent...which I would rather not do. She said it might change according to the outcome of the election. Anyone think I should call back & does anyone have info that I could tell her since she didn't know anything about covering the breast pumps?

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