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Breast pump?

apmomapmom member
in Babies: 0 - 3 Months
Hey ladies, I thought that breast pumps were at least partially covered under insurance now, per the Aca. I called mine and they said it would only be covered if "medically necessary." Anyone have any idea what this might entail and have any info on getting a pump covered? Ty!
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Re: Breast pump?

  • artistlifeartistlife member
    Some policies are grandfathered in and do not have to make the changes. For example, I am a state employee and the insurance there has been in place so long that they do not have to comply with all the parts of the AMA.

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  • cocopuff09120cocopuff09120 member
    It would be medically necessary if there was a problem keeping you from breastfeeding normally I believe (not totally sure). Like if baby didn't latch or couldn't due to a tongue tie or cleft palette
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  • apmomapmom member
    Okay, so since I am part of a state insurance plan they don't have to cover the pump even though I was not part of the plan until last aug? If that's how it is that is ok, just trying to make sure I take advantage of what I am eligible for...
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  • Ninjamama86Ninjamama86 member
    I live in California, to get a breast pump i needed a prescription. We had to wait until after I had the baby because I needed a diagnosis, "lactating," then they shipped it to my house later that week. Talk to your OB.
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  • apmomapmom member
    Thank you ninjamama, I will!
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  • cocopuff09120cocopuff09120 member
    I agree that you need to contact your ob l. I would also contact your insurance company again and ask what exactly qualifies as a medical necessity.
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  • apmomapmom member
    Thanks ladies! 
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  • artistlifeartistlife member
    apmom said:

    Okay, so since I am part of a state insurance plan they don't have to cover the pump even though I was not part of the plan until last aug? If that's how it is that is ok, just trying to make sure I take advantage of what I am eligible for...

    Yes, it goes by the plan not the date you started your policy. It sucks. I didn't get a breast pump either.


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  • YummeeCookeeYummeeCookee member
    I second talking to your doctor. When I called my insurance company, they said I could only get a manual pump. I was going to ask my doc about that and then buy my own electric. And he was like "no, you need a good electric one." I am pretty sure he ordered it for me, citing a medical reason, because I did end up with an electric one through my insurance.

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  • petitmonstreepetitmonstree member
    I agree, see if your doctor can write a prescription. I know my insurance company requires one from my doctor.
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  • JustMeSCJustMeSC member
    I couldn't get a straight answer from my insurance company or several durable medical equipment suppliers in my area. I finally found Aeroflow Healthcare!

    You submit your information, they contact your insurance company to find out your coverage, contact your doctor for a prescription (which shows it is "medically necessary"), and then call you to let you know your cost and get your payment information. I had my pump in less than two weeks and paid only $25 in shipping!

    Check them out here: https://breastpumps.aeroflowinc.com/. Let me know if you decide to use them! It was such a relief when I found them.
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  • cerafina205cerafina205 member
    My insurance requires a letter of necessity from my doctor.
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  • barista411barista411 member
    JustMeSC said:

    I couldn't get a straight answer from my insurance company or several durable medical equipment suppliers in my area. I finally found Aeroflow Healthcare!

    You submit your information, they contact your insurance company to find out your coverage, contact your doctor for a prescription (which shows it is "medically necessary"), and then call you to let you know your cost and get your payment information. I had my pump in less than two weeks and paid only $25 in shipping!

    Check them out here: https://breastpumps.aeroflowinc.com/. Let me know if you decide to use them! It was such a relief when I found them.
    I second Aeroflow! My insurance was difficult to work and someone on my BMB recommended Aeroflow. I contacted them and they completely handled everything for me.
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  • Marchan0912Marchan0912 member
    I had to get an RX from my doctor, I and it was covered 100%
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