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April 2015 Moms
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Grandfathered Insurance Plan.....breastpump?!

cherita1219cherita1219 member
in April 2015 Moms
Im grandfathered into my Aetna insurance plan and I was just wondering if anyone had any luck with getting a covered breast pump through their grandfathered plan. I don't mind paying for one BUT if I could get one for free.... Why not?!
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Re: Grandfathered Insurance Plan.....breastpump?!

  • cherita1219cherita1219 member
    RHoPA1109 said:


    cherita1219 said:

    Im grandfathered into my Aetna insurance plan and I was just wondering if anyone had any luck with getting a covered breast pump through their grandfathered plan. I don't mind paying for one BUT if I could get one for free.... Why not?!



    Call Aetna and ask...

    Didn't think of that.... Thanks!
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  • cherita1219cherita1219 member
    I called them a few weeks back and they won't even entertain my question until I'm at least 36 weeks. I explained to them that I'm high risk for pre term labor but they didn't care. The person I spoke to said that I should try a private company and go through them. Well I tried and all of the private companies I contacted told me the same thing; grandfathered insurance plans do not qualify, blah blah blah. I did read a while ago somewhere on some forum that a few people were successful, I just can't remember where!
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    They should be able to tell you what your plan includes prior to 36 weeks so you can make arrangements as necessary if they don't provide it.
    If not and your insurance is through an employer, you could also call the HR department of whoever it's through and see if they could help. I called my husbands HR department and they helped clarify breast pump coverage when u was still unsure after talking to the insurance company.
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  • islandmom79islandmom79 member
    I used the feature on Aetna's website that allows you to ask questions. I logged into my plan and sent a message asking if my plan covers breastpumps. They emailed me back with the type of pumps covered and the list of vendors I could buy from. It was very easy. I would jusy call again.
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  • boxermamahmboxermamahm member
    I'm with Aetna, though not a grandfathered plan. They provide coverage up to a certain dollar amount for a double electric breast pump ($500 for me); I imagine if they provide coverage for you it would work similarly, so you could buy now and, if there is coverage later, submit your receipt for reimbursement?
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  • taahirataahira member
    I agree asking the question so you can plan ahead is something you should be able to do. You wouldn't have to be 36 weeks before asking that question. Knowing what your plan covers during pregnancy is something we need to know prior to reaching the end.
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  • marisa00marisa00 member
    cherita1219 said:
    Im grandfathered into my Aetna insurance plan and I was just wondering if anyone had any luck with getting a covered breast pump through their grandfathered plan. I don't mind paying for one BUT if I could get one for free.... Why not?!
    I used a resource I found on the Medela website. I put in my insurance (Aetna), and the state I live in, and a list of companies comes up. I called the fist number in the list (which for me was a Babies R Us affiliated number), gave them my info, and they contacted Aetna on my behalf. A few days later I got an email saying which pumps Aetna would cover, and which I could upgrade to for a fee. So, I'm getting a Medela Pump in Style Advanced sent to me for free. If I wanted to upgrade, I could have chosen the Medela Freestyle for $195. For anyone who is interested, here is the link:


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  • travelnut11travelnut11 member
    I just switched to my husband's plan at the new year and was also told when I called that because the plan is grandfathered the ACA rules don't apply.  Thus, no covered breast pump for me.


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  • cwiceangelcwiceangel member
    Could try talking to another person, like a supervisor or whatever.
    Pregnancy Ticker
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  • cherita1219cherita1219 member
    I've done more research and because it's grandfathered it's definitely not covered.
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  • MPKbaby237MPKbaby237 member
    I have a grandfathered plan, too. I've called my insurance company, and I was informed that a pump is not included. Ugh!
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  • cwiceangelcwiceangel member
    I've also heard that a prescription from your dr might get you one... Might want to talk to them.
    Pregnancy Ticker
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  • ScarletOflahertyScarletOflaherty member
    marisa00 said:
    cherita1219 said:
    Im grandfathered into my Aetna insurance plan and I was just wondering if anyone had any luck with getting a covered breast pump through their grandfathered plan. I don't mind paying for one BUT if I could get one for free.... Why not?!
    I used a resource I found on the Medela website. I put in my insurance (Aetna), and the state I live in, and a list of companies comes up. I called the fist number in the list (which for me was a Babies R Us affiliated number), gave them my info, and they contacted Aetna on my behalf. A few days later I got an email saying which pumps Aetna would cover, and which I could upgrade to for a fee. So, I'm getting a Medela Pump in Style Advanced sent to me for free. If I wanted to upgrade, I could have chosen the Medela Freestyle for $195. For anyone who is interested, here is the link:


    Just FYI from an experienced working mama, the Freestyle is not really an upgrade. It *sounds* really cool to not need to be plugged in, but I have seen many, many complaints that the motor is not as strong as the PISA, and craps out really easily. It might be good for *occasional* home use, but if you expect to be pumping with any kind of regularity at all, working or not, stay away from the Freestyle :)
    Due with #5 April 22, 2015. It's a girl!!!!! 

     Yes it was planned, yes we know what causes that, no we are not on public assistance, and yes we will be getting cable after this. ;)

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  • ScarletOflahertyScarletOflaherty member
    Also, for those that are not able to get them through insurance, try Ebay! 

    Remember not everyone who gets a pump from insurance will breastfeed(or be able to, or changes their mind), so it's not uncommon at all to find the made-for-insurance Medela pumps for $40-$50 new in box. The motor on the Medela Pump in Style Advanced starter kit is the same as on the retail PISA, just not in a pretty bag, and that bag isn't worth $200! :) 

    There is also a Pump in Style Advanced with the brown bag that was made for insurance that also has the same motor and can be found on Ebay super cheap.
    Due with #5 April 22, 2015. It's a girl!!!!! 

     Yes it was planned, yes we know what causes that, no we are not on public assistance, and yes we will be getting cable after this. ;)

      image


    image


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  • marisa00marisa00 member
    ScarletOflaherty said:
    marisa00 said:
    cherita1219 said:
    Im grandfathered into my Aetna insurance plan and I was just wondering if anyone had any luck with getting a covered breast pump through their grandfathered plan. I don't mind paying for one BUT if I could get one for free.... Why not?!
    I used a resource I found on the Medela website. I put in my insurance (Aetna), and the state I live in, and a list of companies comes up. I called the fist number in the list (which for me was a Babies R Us affiliated number), gave them my info, and they contacted Aetna on my behalf. A few days later I got an email saying which pumps Aetna would cover, and which I could upgrade to for a fee. So, I'm getting a Medela Pump in Style Advanced sent to me for free. If I wanted to upgrade, I could have chosen the Medela Freestyle for $195. For anyone who is interested, here is the link:


    Just FYI from an experienced working mama, the Freestyle is not really an upgrade. It *sounds* really cool to not need to be plugged in, but I have seen many, many complaints that the motor is not as strong as the PISA, and craps out really easily. It might be good for *occasional* home use, but if you expect to be pumping with any kind of regularity at all, working or not, stay away from the Freestyle :)
    I read the same thing about the Freestyle. I also have a friend who had both the PISA and the Freestyle, and said the PISA was much for efficient - she got more milk and in less time with the PISA.
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  • jesslfarjesslfar member
    Even if your insurance won't cover it, there are often ways around it.  There is a whole list of options that your doctor can write a prescription for including:  multiples, premie,intolerant of formula,suck reflex abnormal,jaundice and more.  If I knew now what I needed to know with the baby that had issues I had a good 10 conditions that the dr could have written a prescription for combined between the baby and I.  Your insurance tells you no, they don't usually give you the exception list.https://www.breastpumps.com/will_my_health_insurance_coverage_pay_for_my_breast_pump  My craigslist and the local mom to mom sites always have PISA for under $100 because so many women resell them and they are often not used or barely used.
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  • attorneyworkproductattorneyworkproduct member
    marisa00 said:
    I used a resource I found on the Medela website. I put in my insurance (Aetna), and the state I live in, and a list of companies comes up. I called the fist number in the list (which for me was a Babies R Us affiliated number), gave them my info, and they contacted Aetna on my behalf. A few days later I got an email saying which pumps Aetna would cover, and which I could upgrade to for a fee. So, I'm getting a Medela Pump in Style Advanced sent to me for free. If I wanted to upgrade, I could have chosen the Medela Freestyle for $195. For anyone who is interested, here is the link:


    @marisa00 if you're still here :(  

    Did you have to send a prescription for your breast pump to be covered? I finally got around to calling them today and before even checking my insurance they said that they would need me to get one at my next Dr's appointment and fax it over. If so, was it any trouble getting one from your doctor? I just don't want to get a pump sent to me and then have it not be covered because I couldn't get a prescription. 
    BabyFruit Ticker
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  • marisa00marisa00 member
    snowboardgurl100 said:
    marisa00 said:
    I used a resource I found on the Medela website. I put in my insurance (Aetna), and the state I live in, and a list of companies comes up. I called the fist number in the list (which for me was a Babies R Us affiliated number), gave them my info, and they contacted Aetna on my behalf. A few days later I got an email saying which pumps Aetna would cover, and which I could upgrade to for a fee. So, I'm getting a Medela Pump in Style Advanced sent to me for free. If I wanted to upgrade, I could have chosen the Medela Freestyle for $195. For anyone who is interested, here is the link:


    @marisa00 if you're still here :(  

    Did you have to send a prescription for your breast pump to be covered? I finally got around to calling them today and before even checking my insurance they said that they would need me to get one at my next Dr's appointment and fax it over. If so, was it any trouble getting one from your doctor? I just don't want to get a pump sent to me and then have it not be covered because I couldn't get a prescription. 
    @snowboardgurl100 Still here, sort of. I'm mostly hanging out in the other pool, but I can't help myself from reading all the crazy drive-by posts and the witty responses from all the non-banned regs.

    As for the pump, I did need to get a prescription. My midwife had no problem writing one for me, and said it was a common request ever since the Affordable Care Act went into effect. If you think it might be difficult to get a prescription, then you could wait until you have one in hand before telling the company which pump to send you. This is actually what I did - got the prescription, and then told them which pump I wanted.
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  • attorneyworkproductattorneyworkproduct member
    @marisa00  Thanks so much! I don't think it will be a problem from my doctor but your approach sounds like the safest way to go. 
    BabyFruit Ticker
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