BCBS/Approved DME supplier in Atlanta area?

LucyRicardo3 · December 2013

Hi!
I am hoping someone on here has information to help me find a DME (durable medical equipment) supplier in the Atlanta area, preferably north-northwest area that will sell or rent Medela breast pumps and is also a Blue cross blue Shield PPO approved provider.

My insurance gave me a list of several and for different reasons, none of the many I've called can help me out. Most of them don't carry breast pumps.

My little one is currently in the NICU and will be a long while before he can BF, so I need a really good pump.
I'm renting one from the hospital for now, but Im really hoping to find something that my insurance benefits can actually help me out and reduce my out of pocket.

Thanks for your time!

slwprincess · December 2013

I have BCBS too- the Federal Employees Plan... here is the number they told me to call- it's their Pharmacy Line. Haven't called them yet though...

800-262-7890

Also, which hospital did you deliver at? Kennestone has a Lactation store inside the hospital (or they used to?) and I believe they count as a DME. Give them a call to find out? Did you call BCBS Customer Service?

LucyRicardo3 · December 2013

My bcbs is an out of state plan, but as long as a supplier participates in the local bcbs PPO then I'm supposed to be covered at 100% of the pump cost.

I delivered at northside-atlanta.
They also have a lactation department & a boutique that I rented this pump from, but I was told by the lactation nurse they are not "DME" certified by BCBS.

My plan requires a Rx from my dr (which I have) and I have to take it to one of their approved DME suppliers and bcbs will cover the cost of purchase or rental at 100%. However, the BCBS customer service sent me a 3 page list of possible suppliers, based on my zip code, but none of them stock breast pumps, only convalescent (sp?) equipment.

I've also called Apria and Hi Tech and neither of them can help me.

It's like being issued a winning lottery ticket, but no where to cash it in. I've gotten so frustrated.

I'll call Kennestone and see if someone there can help me with this. Thanks so much for the suggestions!

jnnfrrose6 · December 2013

I'd also call customer service back and let them know that no one on the list they provided carries what you need. See if they can expand the search parameters for you or something to get a better list.

GL!

LucyRicardo3 · December 2013

I just did a search on the bump and found where someone had success with Byram (on an older thread from the breastfeeding board.) I've left a message with their pump hotline and maybe someone will call me back today...

slwprincess · December 2013

You know, I didn't think about it until just now but now I'm wondering if the problem is that you want a Medela? BCBS told me they are only covering Ameda. But again, maybe it varies from plan to plan.

MsAmeera25 · December 2013

We used CVS caremark but its BCBS federal so I think it may be different because I didn't need a script. Also they are only covering Ameda double electric or the manual unless your plan covers something different.

hakeberrr · December 2013

Yes, Byram worked for me! Good luck!

LucyRicardo3 · December 2013

ok, I didn't realized BC may only cover Ameda.. No one else has mentioned that to me. It was a crazy weekend and Byram never called me back last week. Hope to get it resolved soon!

LucyRicardo3 · December 2013

I found one that can rent the Medela Symphony to me as I have medical necessity for a hospital grade pump

In case anyone needs the info in the future, call
Medical Aid Supply House on Peachtree Industrial Drive in Duluth

I have to fax them my info, my rx, and a letter of medical necessity and they will have the equipment waiting for me, hopefully!!

Thanks for the advice and help!

Mrs. Theobald · December 2013

You're better off to find a mail order DME. The problem is that your insurance will give you a list of DME approved companies but that's general DME (beds, walkers, etc). Most DME companies don't carry breast pumps bc they don't make money off of them. Kennestone lactation department is not considered a DME. The other thing is you don't get to select what type of pump you get. In most cases the insurance company will tell you which pump you get. I have an Ameda Purely yours and love it. I've used both and prefer the Ameda bc it's a closed system. I got my pump through Care Point Medical. I've also heard of people who have had success with Edge Park. Both are mail order companies.

jaholt22 · January 2014

My BCBS plan recommended Edgepark. They have Medela and Ameda. It's a mail order, but my coworker got hers in 3 days. They contacted the OB for the RX and everything.

LucyRicardo3 · January 2014

Thanks, everyone!

Medical Aid Supply House of Duluth is able to process my order. YAY

BUT- since I am needing a hospital grade (Medela Symphony) rental due to my little one's prematurity and inability to nurse or take a bottle and I must exclusively pump and keep up my supply, then my BC is going to process this a little different than the typical breast pump order, even with the Rx and and Letter of Medical Necessity from his neonatalogist

The Hospital grade pump has a different code of E0604. It does not fall under the ACA mandate. So, with the letter of med nec, they will apply the approved cost of the rental to my deductible (which in my case, I've met due to the several triage visits, etc, with a high-risk pregnancy.) It is only under the "4th quarter carry over". With LO still in the NICU and staying there through mid February, it is most likely we will easily meet the family deductible, as well.

So, at least I will get some "credit" for the rental, or possibly covered since it's questionable when they are considering my deductible as being met, since some claims haven't been processed as of this date.
MASH is requiring a security deposit check of $500 that they say they will not cash, but will return to me when I return the rental pump.

THEN-
After I turn in said rental, I can still qualify for the ACA pump coverage with the Medela Advanced, at 0% out of pocket, and M.A.S.H. will process that for me, as well.

This will prevent me from having to buy new accessories since I've been using Medela up to this point, and I have the tubing from my old pump that will convert to the new one.

Hope this is helpful to anyone else in this preemie predicament in the future....

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