Affordable care act and breast pumps

CanadianintheSouth · May 2014

So I was all excited that I could possibly get a breast pump through insurance. I called my insurance today (BCBS) and found out that my plan has been "grandfathered in" which means I am not eligible for a breast pump through the act right now (wtf?!) Also the act apparently now only covers manual pumps. Anyone else having issues? Looks like I will be buying my own... any suggestions regarding brands or styles that you like?

guppybaby · May 2014

That is so odd, I have BCBS as well and had no problems at all.

Got the Medela Pump in Style. I would call back and ask to speak with a supervisor.

missmiss307 · May 2014

Actually, what it covers depends on your insurance. Mine will cover the Medela Pump in Style Advanced, I believe. I've heard of others only covering a manual pump.

Sorry your insurance company is being lame. I would guess that it has to do with all the pushback on the implementation of the Affordable Care Act and the fact that some older plans were allowed to continue for the time being.

Rannndi · May 2014

I have Humana, but mine definitely isn't manual. I also got a Medela Pump in Style.

caballablanca · May 2014

I won't know what I get, cause we have to wait until closer to the due date and its whatever they have in stock at the place I can order from, but ive heard it may be the amenda purely yours from others at work.

CanadianintheSouth · May 2014

It think it had to do with the state that I have it in. Live in TN but have BCBS in Arkansas because I tried calling the number from the medela website and they told me that AR was out of network even though the website said it wasn't. Thanks @pink021! Will keep an eye out

sarahg8r · May 2014

That sucks! I just called yesterday and BCBS of Florida covers a manual or electric pump. I'm not sure who would want a manual one, though! Anyhow, I'm not sure exactly which one it covers because they can't tell me that until they order it and I can't order it until I register with the hospital. I just know it's a Medela.

kaitm22 · May 2014

I have BCBS of Minnesota, although we live in Wisconsin, hubby works for a MN based company. I can only get a manual pumped so I just went ahead and registered for a double electric.

enigmasara · May 2014

I am able to get the Medela Pump in Style which I have heard (not sure if it's true) is going to be the only Medela double pump that will be covered by insurance in general. Other brands & styles will still also be offered of course. My friend's insurance only covers a hand pump.

[Deleted User] · May 2014

I have BCBS in Pennsylvania. They told me it depends on your particular insurance whether it covers manual only or electric. I am able to get a double electric, but I have to wait until baby is born to get it. I wish I could get it just a little early...but I also understand that they don't want people getting them just to resell. I have to call the supply on my own beforehand and figure out who I want to order from and which pump I want. It's actually overwhelming, but I'm glad that it's being covered, so I can't complain.

CanadianintheSouth · May 2014

@weeklyplanner‌ I'm not even eligible for the manual one until 2015 which doesn't help me at all. For now I get nothing. Oh well, I guess the bright side is that I get to pick the pump that I want!

BlckRoses · May 2014

I have BCBS and they cover a double electric, and I have a choice of three different types through the provider they use. I think I'm going to get the Medela one, I'm not sure which model it is, but it's a nice one. I can't order it until after the baby comes, but they said it'll only take 5 days to get to me once they put the order in.

mislogis · May 2014

Mine covers all pumps except hospital grade. One every 12 months

sharkmama39 · May 2014

I have BCBS and it covers manuals purchased anywhere (like Target) but to get electric, I have to get a prescription which is what I am doing.

The one annoying thing is that all of the medical distributors in the area don't carry pumps so I have to use the online resource which doesn'tlet you order until 30 days prior to your due date. I just want to get it now and be done with it so that I can check one more thing off my list!

Kelliwilsoca · May 2014

I know they can be counted off taxes not sure if covered though by insurance

Burnntoashes6402 · May 2014

I have BCBS and my insurance covers both manual and electric pumps. Getting my Dr to write my Rx Friday when I go so I can get mine ordered.

mislogis · May 2014

Can I say how EXCITED I am to get a double pump fir this baby? I had a single, and it was such a pain to do one breast at a time. SOOOO excited

kristenpedersen · May 2014

BCBS of MA.. A double electric is covered.

GreenMonkey1 · May 2014

Check and see if a breast pump is covered under the Durable Medical Equipment (DME) part of your policy. My health plan also was grandfathered under the ACA, but a breast pump qualifies as a DME and is covered. Unfortunately, there is nothing written down in the policy so I am a little confused as to what type of pump specifically is covered (single/double, manual, etc.) and will have to call back.

CanadianintheSouth · May 2014

Thanks for the advice everyone, will keep trying! If it doesn't work out, I will just wait for a sale

forevermyfenix · May 2014

mv9310 said:

We have Tricare and pumps are not covered unless medically necessary.

Oh I was so hoping what I was reading wasnt true...

kcatboston · May 2014

mislogis said:

Mine covers all pumps except hospital grade. One every 12 months

I'm almost positive mine is every 12 months also. Would I be a horrible person if I got a second one so I can have one for work and one for home...

smfdjo · May 2014

Every policy is different, doesn't matter if it is BCBS or what state. It only matters how the policy is written. Is the insurance through yours or your so company or did you take private insurance through the exchange or direct?

forevermyfenix · May 2014

RedFirePhoenix25 said:

artgeek009 said:

mv9310 said:

We have Tricare and pumps are not covered unless medically necessary.

Oh I was so hoping what I was reading wasnt true...

This is ridiculous. Military insurance doesn't cover it, really?

nope. called and they basically told me unless the baby medically needs it (like a premature in a NICU situation), they dont cover breastpumps.

GinnyJ2012 · May 2014

I have UHC through DHs work and our policy doesn't cove pumps at all. I have one from when DS was a baby, but was hoping to get a new one.

For those whose insurance only covers a manual pump, I would still get one. I started with a manual pump when DS was born and it wasn't too bad to use. I was able to pump 4-8 oz at a time in addition to nursing.

sekura · May 2014

I own the Ameda Purely Yours, used it and a hospital rental last pregnancy. This time around I'm going to rent the Hospital one (a Medela Symphony) the entire time I'm pumping. It was much faster, and more effective--sometimes the Ameda wouldn't get anything from my right breast (which always produced less, but did ok with the Symphony). Quieter, too, which is nice at work. It can be more expensive to rent than buy, but if you're out of pocket anyway, the time and hassle savings can make it worth it.

chase16 · May 2014

artgeek009 said:

RedFirePhoenix25 said:

artgeek009 said:

mv9310 said:

We have Tricare and pumps are not covered unless medically necessary.

Oh I was so hoping what I was reading wasnt true...

This is ridiculous. Military insurance doesn't cover it, really?

nope. called and they basically told me unless the baby medically needs it (like a premature in a NICU situation), they dont cover breastpumps.

It's some kind of loophole since tricare is technically a "benefit" and not insurance.. Not gonna lie, I appreciate the free medical care.. But sometimes I wish I paid into insurance so the army could afford better doctors/better care.

brookerachelej · May 2014

RedFirePhoenix25 said:

cath5587 said:

I don't think it's insurances that are grandfathered in but companies. For me, at least, that was the dilemma. I have United Healthcare but my company is grandfathered and doesn't cover anything at all.

This. It depends on the company and the type of plan they have. I have insurance through H (UHC) and mine is covered. I may have to pay some if I go with a higher end model, like @stoofewok, but I just have to complete a request and the DME company will contact my doctor to get everything needed. It stinks that all plans didn't convert to covering this at the same time.

This. It's not the state or the insurance plan but the company and the type of insurance you have with them. I have BCBS if IL, called and mine is considered a self-pay plan and we are grandfathered in so no coverage for a pump.

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