Hi,
So I read several articles that state under the affordable care act breast pumps must now be covered by insurance companies. I have GHI and was just told that this is only if the baby is in the nicu or has some other problem where a pump is deemed "medically necessary". I have done tons of research online and it seems that everyone's insurance has a different response. So, I don't get it. Does the law say they have to cover it or not? My insurance company read me the "provisions" which I do not trust at all to be the actual provisions of the health care law. Anyone who works in the insurance industry or health care field who can shed some light on what is going on?
Re: Breast pump frustration
I don't know for sure, but from other things I've read about this, simply going back to work after having the baby is cause for a 'medical necessity' and your doctor should be able to document that for you.
I've heard that many companies won't follow through until after the baby is born, though.
Good luck!
My insurance company doesn't cover them period, regardless of the reasons. Check out your local WIC (Women, Infants, and Children) program and see if they have one you can rent or borrow. That is how I got mine!
When I was nursing DD#1 they randomly asked me if I needed a breast pump, and I wound up getting to borrow a really amazing double model. They told me to keep it as long as I was still bfing, and return it when I had weaned and had dried up. When I went to turn it back in, they told me that they had just gotten a grant to buy all new machines, so I got to KEEP it permanently. It was awesome.
I have a different insurance company but it literally took me 15 phone calls over a 4 month period to finally get the same answer twice... so I would call back and talk to someone else because no one really knew and they were just giving me random answers. Finally I found out my pump is covered at 100%- it should be here next week. So call back and try someone new!
Also, my OB gave me a prescription (even though I don't need one for my pump) and she stated it was medically necessary... so I would ask your OB if they can write that on your RX.
You are required by law to get one for free if:
1) your plan is not "grandfathered"
2) you started a new plan on or after august 1, 2012
3) you renewed your current on or after august 1, 2012
BCBS gave me such a runaround, you wouldn't believe it. They denied me five times before I finally got mine. You have to be persistent and remind them that they aren't above the law and you won't hesitate to start a class action lawsuit.
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