RANT!! Stupid F'ing insurance

chavemann10 · February 2015

So, I've been trying to get an answer from my insurance company about what type of breast pump they pay for and if I need to buy it from somewhere in particular. I get an email from them stating, "Your medical plan unfortunately does not provide coverage for a Breast Pump." I emailed them back and told them that according to the Affordable Care Act of 2010, the insurance company is required to cover the cost of a breast pump. The reply I received today, "The medical plan does not follow the Health Care Reform. An appeal can only be submitted after the birth of the baby, and the claim has been denied as not covered under the plan." Can anyone tell me if this is even legal? I mean, I can buy my own, but why should I if I am paying so much a month in insurance and they are supposed to cover one. I really just want to scream. Between my HR being an a**hole about me wanting to pump and them having to find me a secure location to do it, and now this with our insurance...really? I just want to crawl back into bed! I'm soooo done with this day!

Miz_Liz · February 2015

I had to wait until after DS was born then the Dr gave me a prescription saying he wouldn't latch.

xcitdmomma · February 2015

https://www.healthcare.gov/coverage/breast-feeding-benefits/

https://www.healthcare.gov/health-care-law-protections/grandfathered-plans/

Looks like it's not all plans. Is yours grandfathered?

sandrabrooke · February 2015

Ugh I hope you dint have the grandfathered plan. We get the pricey medela one

chavemann10 · February 2015

I have no idea. I just looked up my book and I didn't see anything in it about being grandfathered. I will email them back tomorrow. I'm too pissed right now to do it. Lord knows I'd say something I shouldn't. Thanks ladies!

Miz_Liz · February 2015

Try not to stress, sometimes I think the greedy insurance companies require the prescription, but the Drs give them out like candy...I got one from my OB, one from the hospital, and one from the Pedi.

Lalala2326 · February 2015

Yea not all insurance plans cover (like grandfathered ones), and even ones that do cover do not necessarily cover what you want them to. They can choose to only cover rental, just a single manual one (which are really cheap anyway), etc... There is a lot of leeway in that requirement and every insurance plan is different.

Any chance you qualify for WIC? Most people I know have been able to get a double electric for free easily from WIC. I don't qualify but my sister just walked in and asked for one, and they handed one to her on the spot. I had to go through my insurance and find a random supplier out of state (none in state would work with my plan) that would actually supply one with my insurance and have it shipped which took several weeks. Insurance just sometimes sucks.

Miz_Liz · February 2015

Lalala2326 said:

Yea not all insurance plans cover (like grandfathered ones), and even ones that do cover do not necessarily cover what you want them to. They can choose to only cover rental, just a single manual one (which are really cheap anyway), etc... There is a lot of leeway in that requirement and every insurance plan is different.

Any chance you qualify for WIC? Most people I know have been able to get a double electric for free easily from WIC. I don't qualify but my sister just walked in and asked for one, and they handed one to her on the spot. I had to go through my insurance and find a random supplier out of state (none in state would work with my plan) that would actually supply one with my insurance and have it shipped which took several weeks. Insurance just sometimes sucks.

We had to get ours from a medical supply store too now that you mention it, luckily there is one near us. They carried Medela and we got the nice double pump free.

daniellepanda · February 2015

I looked into mine and it says they only cover 1 rental breast pump with the prescription from a dr. luckily i still have my medela pump from my son.

mamaloaf · February 2015

I really hope you don't have one of those plans that doesn't have to cover a pump. If you do, you might consider starting to look around for a used one that someone doesn't need anymore, or quite possibly never used. Breastfeeding just doesn't work for everyone, and I know multiple moms who got "free" breast pumps from their insurance and never used them.

Some may be grossed out by the thought of a used pump, but if you know how one works, you know that milk doesn't actually flow through the tubes or into the machine itself. So if I were to go down this path, I'd find a good used machine and purchase new tubing, membranes and correct fitting flanges. Do your initial boil of parts as instructed and have at it. $50 seems to be a good rate for a used double electric pump around here.

Also, having to lug around one pump can be a pain. Some people go this route just to be able to leave one at home and one at work.

chavemann10 · February 2015

Thanks Ladies! I have decided to hold off on emailing them back until I talk to my doctor. A girlfriend of mine said that no matter what, if the doc writes the script, they have to cover it. I don't know how true it is, but since i have a cheap one from my last pregnancy, and don't plan on starting to seriously pump for about 2wks (based on last pregnancy), I'm going to hold off. I appreciate all the advice. And to answer @Lalala236, no, we don't qualify for anything, since I am back to work full-time. Thanks for the suggestion though.

thesportsgal · February 2015

Also, mine only covers a single manual pump. I didn't even bother, since I needed/wanted a double electric. So even if you get a prescription, it still might not even be for the pump you want.

xcitdmomma · February 2015

chavemann10 said:

Thanks Ladies! I have decided to hold off on emailing them back until I talk to my doctor. A girlfriend of mine said that no matter what, if the doc writes the script, they have to cover it. I don't know how true it is, but since i have a cheap one from my last pregnancy, and don't plan on starting to seriously pump for about 2wks (based on last pregnancy), I'm going to hold off. I appreciate all the advice. And to answer @Lalala236, no, we don't qualify for anything, since I am back to work full-time. Thanks for the suggestion though.

Talk to your doctor, get codes for everything, and check them against your insurance.

All plans are different and cover different things! Ours covers nothing in pregnancy unless you disclose within certain time frames, our fertility treatments needed pre-authorization. Just a warning - don't get slammed with an unexpected bill!

jessandandy09 · February 2015

I just want to say WTF?! On medicaid in Illinois, YES FREE INSURANCE for the poor, you can get a double electric pump for free with a prescription. FREE.

I am not trying to knock it, because it is a great program to help provide breast milk to low income families and to reduce the cost/ dependency on formula. However, if free insurance gives them out for free, shouldn't your "paid" insurance be helping you???

I am livid on your behalf.

Please nominate your insurance company for Twatwaffles of the year.

xcitdmomma · February 2015

jessandandy09 said:

I just want to say WTF?! On medicaid in Illinois, YES FREE INSURANCE for the poor, you can get a double electric pump for free with a prescription. FREE.

I am not trying to knock it, because it is a great program to help provide breast milk to low income families and to reduce the cost/ dependency on formula. However, if free insurance gives them out for free, shouldn't your "paid" insurance be helping you???

I am livid on your behalf.
Please nominate your insurance company for Twatwaffles of the year.

Insurance is expensive, and they all cover different things. If you are insured through your employer, you usually have few to no options regarding the plan type. Also, if you pay out of pocket you would only pay for a plan you can afford on your salary. Most people don't qualify for medicaid unless they make less than a certain amount per month.

It's not a perfect system. We have fantastic insurance, but it still doesn't cover everything. I'm thankful we have coverage and won't have to pay for everything out-of-pocket.

jessandandy09 · February 2015

xcitdmomma said:

jessandandy09 said:

I just want to say WTF?! On medicaid in Illinois, YES FREE INSURANCE for the poor, you can get a double electric pump for free with a prescription. FREE.

I am not trying to knock it, because it is a great program to help provide breast milk to low income families and to reduce the cost/ dependency on formula. However, if free insurance gives them out for free, shouldn't your "paid" insurance be helping you???

I am livid on your behalf.
Please nominate your insurance company for Twatwaffles of the year.

Insurance is expensive, and they all cover different things. If you are insured through your employer, you usually have few to no options regarding the plan type. Also, if you pay out of pocket you would only pay for a plan you can afford on your salary. Most people don't qualify for medicaid unless they make less than a certain amount per month.

It's not a perfect system. We have fantastic insurance, but it still doesn't cover everything. I'm thankful we have coverage and won't have to pay for everything out-of-pocket.

yes, they do all cover different things, but the nationwide push starting in 2010 and then enacted in 2012 was for insurance to be required to cover or assist with getting a breast pump. A few "private" insurance companies were grandfathered in. If you have decent insurance and especially if it is expensive, you should be getting assistance. I also am lucky to have insurance through my employer. They do assist with everything medical, but not vision or dental. The point is, Insurance companies are asshats for being allowed to make up their own "rules" find "loopholes" to not provide you assistance that you pay for every single paycheck and for denying claims. Not only is is not a perfect system, it is a fucked up giant mess of a system.

chavemann10 · February 2015

jessandandy09 said:

I just want to say WTF?! On medicaid in Illinois, YES FREE INSURANCE for the poor, you can get a double electric pump for free with a prescription. FREE.

I am not trying to knock it, because it is a great program to help provide breast milk to low income families and to reduce the cost/ dependency on formula. However, if free insurance gives them out for free, shouldn't your "paid" insurance be helping you???

I am livid on your behalf.
Please nominate your insurance company for Twatwaffles of the year.

Thank you! Medicaid in Texas pays for them as well, but because we are "middle class"(although my bank account begs to differ), we don't qualify for Medicaid. I'm really really hoping the doctors note will help. I am just preparing myself for a fight. We didn't have this insurance company last time around, as my husbands insurance was primary. But, thanks to Obama, my insurance is now primary because my birth date falls before his. It sucks, but I have no choice.

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RANT!! Stupid F'ing insurance

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