Breast Pump Coverage..denied!

mbobrow1 · August 2014

I've been putting off calling insurance- and when I did today, I learned that with DH's insurance- it is not covered under medical supplies. The woman told me that I could always appeal this decision. I didn't think to ask at the time what that entailed, or if it was ever effective.

Any STM's with experience?

Emerald27 · August 2014

I've appealed many an insurance claim rejection. It typically involves simply filling out a form and having your doctor mail a letter of medical necessity, or disputing based on diagnosis codes, or something...it really depends on what service was rejected and why.

I wouldn't jump to appealing the rejection yet. I'd call back and speak with someone else, don't mention your earlier conversation but just tell them that you understand breast pumps are covered under the Affordable Care Act, you're expecting a baby and want to know what you need to do in order to acquire the breast pump they cover. See what the different rep says.

ss265 · August 2014

If you have a grandfathered insurance plan, it won't be covered. That's what I have with my employer's insurance. But definitely call back and ask.

lrobi13 · August 2014

I tried but my policy does not cover it. It sucks but the pump is still cheaper than formula. Really hoping I have a supply when it is time. I will probably rent from the hospital before I buy one just to make sure.

bennikki · August 2014

Ditto the grandfathered plans issue. My sister's insurance didn't cover hers; she's a union nurse. They did tell her when her contract came up for negotiation in a few years, it would probably be included, but for the time being, she was out of luck. The same thing happened to another woman on my previous BMB, and her DH's plan was a union electrician plan.

NavyFlyer · August 2014

Mine only covers it if you have a preemie in the NICU :0( Good luck, hope you are able to work something out with yours!

MsMacual · August 2014

Did you ask if they will cover one if deemed medically necessary by your doctor or your child's ped? Our first was born before the ACA went into effect and our policy was worded this way. Both my MW and our ped were more than willing to write the scrip for us to get our pump under our insurance (our ped ended up writing ours). I paid about $85 for a Medela Pump in Style which was a huge savings from the retail price. I'd call back and ask- it wouldn't hurt.

I definitely would file the appeal if you have exhausted all other avenues. Breastfeeding supportive providers (both yours and your ped) will be more than happy to provide documentation stating that you need a pump.

If all else fails, you could purchase a used pump- just be sure to only buy one that has a closed system (Hygeia definitely is one. I think Ameda also is a closed system).

MrMrsandBaby · August 2014

Mine covers it as DME too so that doesn't necessarily mean it is a grandfathered plan. My coverage is good though (two electric pumps per benefit year!).

ACA just requires that a pump be covered. It may be a manual pump, it may be a rental and it may be an electric, but if the plan is an ACA plan (and most are unless grandfathered) something needs to be covered by it.

Justabean3 · August 2014

Check your benefits book and look for durable medical equipment AND under lactation coverage

I had to literally tell them what page of the book my coverage was on and then she found it. They told me a lot of insurance is behind on knowing actual coverage and look at previous coverage because they just can't find it. So they quote that.

Dubsgirlie · August 2014

My insurance doesn't cover them at all.

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Breast Pump Coverage..denied!

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