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June 2013 Moms
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BCBS Breastpump coverage

duffmakerduffmaker member
in June 2013 Moms

I have Excellus btw I'm not sure if it varies from specific plan to plan or if BCBS's policy on pump coverage is the same across the board?

I have to call them tomorrow but I did some looking on their website and found a policy that says this:

I. Electric breast pumps have been medically proven to be effective and are considered medically appropriate when illness or injury of the mother or infant prevents normal breastfeeding and when a manual pump is ineffective (e.g., inability to express breast milk).
II. Manual Breast Pumps do not meet the definition of Durable Medical Equipment (DME) and are therefore considered ineligible for coverage. Manual breast pumps are used by healthy persons, do not require order or prescription by a physician, are unable to be reused by other patients, and are not treatment for an illness or injury.
III. Heavy duty, hospital grade breast pumps do not meet the definition of Durable Medical Equipment (DME), as they are not to be used in the home. Heavy duty, hospital grade breast pumps are, therefore, ineligible for coverage.

My take on it is that they will cover a brand new electric breastpump, maybe requiring a doctor's note, but nothing else. No rentals, no manuals, no hospital grades etc.

Does anyone else have BCBS (even more specifically Excellus)? Have you spoken to anyone directly about this, or do you have any more information or clarification about their policy?

TIA!

Proud babywearing, breastfeeding, vaccinating SAHM of 2U2!
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Re: BCBS Breastpump coverage

  • BabyShanteauBabyShanteau member
    I am getting ready to call on Monday...My husband is changing jobs soon, so I'd like to get this taken care of before he makes the switch.
    L.M.
    6.13.13 
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  • AlliSamAlliSam

    I called with my son (2 years ago) and they told me it wouldn't be covered unless we were separated (if he was in NICU or I had to have extra surgery beyond csection or prolonged hospitalization) or if he had a medical need for needing expressed milk (cleft pallet, failure to thrive, etc)

    BUT since the new obamacare thing January 1st I think it's changed.  Not 100% yet.

    Baby #2 Due 6/10/13! EBF, Babywearing, Cloth Diapering, ERF, homemade babyfood making, "semi crunchy" momma! Baby Birthday Ticker Ticker BabyFetus Ticker
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  • bonita_darlingbonita_darling
    I called my insurance the other day (UMA) and they said they're opting out of that requirement. I guess I didn't realized there was a way to opt out...I was so disappointed:(
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  • bumpuser8448316bumpuser8448316 member
    imageAlliSam:

    I called with my son (2 years ago) and they told me it wouldn't be covered unless we were separated (if he was in NICU or I had to have extra surgery beyond csection or prolonged hospitalization) or if he had a medical need for needing expressed milk (cleft pallet, failure to thrive, etc)

    BUT since the new obamacare thing January 1st I think it's changed.  Not 100% yet.

    Those are the requirements my insurance has too and it hasn't changed since the new healthcare act. They have to cover them but they can impose restrictions.


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  • TeamHayesTeamHayes member
    I have bcbs of ma. My last pregnancy I just had to call a supply co and they sent me one overnight for free, no notes or anything required. I got a medela pisa, and I had already bought one so I kept one at home and one at work. Much easier than lugging that pump back and forth all the time.
    Kellen 4.27.12 Miller 6.30.13 Baby #3 edd 9.7.15
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  • mdesmond2320mdesmond2320 member
    I called my BCBS and they told me they would not cover it.  Maybe I need to call back and see if they were just trying to put me off or something.  But I do live in a state and have a job (BCBS is with them) that does not like pregnant women so who knows.
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  • RIngReadyRIngReady member

    imagemdesmond2320:
    I called my BCBS and they told me they would not cover it.  Maybe I need to call back and see if they were just trying to put me off or something.  But I do live in a state and have a job (BCBS is with them) that does not like pregnant women so who knows.

     

    DH has BCBS of WY and we added it as my secondary ins. a few months ago. I called and BCBS said they did not cover any breast-feeding devices at this time. I guess it varies state by state and probably by policy too.   

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  • Amanda2034Amanda2034 member
    Hi everyone, I thought I should comment here since it pertains a lot to me personally as I work for a DME company in Rochester, NY. I want to say first to be careful where you get your pump. Make sure you are speaking with a customer service rep who actually sounds like they have a decent understanding of the new coverage criteria through insurance. Your local DME company is always your best bet. What happens is you may end up getting screwed over excuse the expression ;with a bill afterwards because the person you were working with wasn't careful enough. Please call me directly if you live in the state of New York with BCBS and need one. All the pumps I've done were covered in full and they are great quality Ameda dbl electric I'll walk you through it, it's all actually pretty quick and simple. 5852278750 and ask for Amanda N. :
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  • Amanda2034Amanda2034 member
    Hi everyone, I thought I should comment here since it pertains a lot to me personally as I work for a DME company in Rochester, NY. I want to say first to be careful where you get your pump. Make sure you are speaking with a customer service rep who actually sounds like they have a decent understanding of the new coverage criteria through insurance. Your local DME company is always your best bet. What happens is you may end up getting screwed over excuse the expression ;with a bill afterwards because the person you were working with wasn't careful enough. Please call me directly if you live in the state of New York with BCBS and need one. All the pumps I've done were covered in full and they are great quality Ameda dbl electric I'll walk you through it, it's all actually pretty quick and simple. 5852278750 and ask for Amanda N.
    Report Reply
  • dlm0601dlm0601 member
    Amanda2034 I live in rochester ny as well but really want a Medela PISA... Do you know if bcbs enhanced plan with rcsd will cover it fully?
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  • JessicaKSJessicaKS member
    I just read that whole thing and couldn't figure out who those "new" posters were, and why people were just getting their pumps now!! And then I saw the dates!
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