Breast pump only covered if medically necessary??

DarlingNIkki1028 · January 2013

Mobile users: Breat pump only covered if medically necessary??

So I know there have been a lot of insurance-related breat pump questions lately, but I'm still unclear. I had just planned to wait till the new year to call my insurance and get information. I called the other day, and they told me it's only covered if medically necessary for the baby. Meaning, if she has a disability that makes it difficult/impossible for her to latch, or we are separated due to hospitalization of either the mother or baby, it's covered. Otherwise, it's not.

I was under the impression that the new care act did not require medical necessity for the pump to be covered, either by purchase or by hospital rental.

So, my question is, did I get false information? Or is this one of those loopholes? If it helps at all, my insurance is Cigna.

jesslynfaith · January 2013

I'm not sure if its covered on insurance (I would think probably not) but I do know regardless that you can use a Flex Speding Account to pay for it...

OhSewCrafty · January 2013

It depends on your insurance carrier. I'm part of a state employee trust fund and almost none of the Affordable Heath Care Act affects our benefits. Other insurance carriers just haven't caught up with what the law actually is.

skoogirl · January 2013

I have Cigna and it's covered. Might just be your policy specifically.

wdwrocksmysocks · January 2013

You might call back and ask if it's covered under preventive care. I had previously called and was told that it wasn't covered. Then, I called back and asked it was covered under the new act and they said it was under preventive care (meaning they'll cover 100% of the cost, regardless of deductible).

Good luck!

can_can · January 2013

I think I read other ladies with Cigna could have their doctor write them a prescription for the breastpump, to get it covered. Might be worth asking!

chelchel77 · January 2013

My insurance (BCBS) also requires medical necessity, but the way it was explained to me is that having a prescription written = medical necessity. So as long as my doctor agrees to write a prescription for the pump, and I get it from a durable medical equipment supplier (in-network, of course), insurance will cover it. I can't see any reason why the doctor wouldn't write a prescription for me. So maybe some hope for you as well?

StarBe · January 2013

it really still depend on the plan - some plans have been able to "grandfather" older rules etc.IT never hurts to call and talk with anemone else though - I had a horrible nightmare recently with CVS/Caremark and I talked to 6 different people and each one, yes 6 for 6, all told me different things.. issue is still not resolved. So call Cigna again and see if you get a different answer

That said if you still need a medical necessity ask your dr for a note - many times it's considered medically necessary if you are unable to BF for whatever reason (i.e. you have to work.) Definitely ask, most drs are happy to help when it comes to feeding your child

sms04j · January 2013

I have BCBS in FL through the school district. I called yesterday and was told that only manual Breast pumps were covered and theat they would send me one. I figure it is free , so I should take advantage of it.

jkjjess627 · January 2013

I have Federal BCBS and called CVS/Caremark on Wednesday to get information, the women on the phone told me what brand was available and gave me the option on manual or electric, she put me on hold for maybe 3 minutes while she looked into whether or not it was covered when she got back on the line she told me I would receive the pump along with 150 storage bags within 10 days. I would definitely call again.

ChicagoBulls · January 2013

I have a PPO through Cigna. I called them to find out if a pump would be covered, and they stated that because my insurance is part of a self-insured program it was not covered. That really upset me!

hatroopes · January 2013

I have CIGNA and my plan states that as well, but the rep explained that it simply means the baby has to be born first. I would check again with them to make sure.

lpstjohn · January 2013

I work in benefits and am currently working on this issue with one of our employees to get hers paid.

Breast pump rental/purchase is a part of health care reform and if your plan is to follow federal regulations (some only have to follow state) then the pump will be covered at 100%. However, it is not all pumps and your insurance can give you a list of the covered ones. You also have to get from a hospital or durable medical equipment facility. These cannot be purchase at retail stores such as target, babies r us.

Hope this helps!

brinkman17 · January 2013

I was just discussing this today with a friend of mine. She said our insurance at said the same thing, but everyone was telling her it could be covered. When checking into it, she figured out that she just needed a prescription from her doctor and then she went to a medical supply store to get one. That is my plan!

ceamac0127 · January 2013

Pumps are covered by my new insurance but when I started calling last year they told me I needed to have a letter of medical necessity so I just asked my OB for one. She wrote out "a breast pump is medically necessary" and that was it. I would ask your dr and I'm sure they will do the same for you! Good luck!

nyki06 · January 2013

If your policy hasn't renewed yet it's my understanding that they can still go by the old rules, which are that they only have to cover if it's medically necessary. The breast pump coverage is good for three months after your LO is born so if your coverage renews soon or around the time the baby is born you should still have time to get the pump.