Insurance breast pump

NachosAndPeaches · October 2015

I know I read in one of the shopping threads that some of you got breastoumos already, but I don't remember which so I'm starting my own thread.

Last pregnancy we had TriCare, which is the best insurance I've ever had (medicated birth and week long NICU stay cost us $50 lol). BUT they somehow got in a loophole that they didn't cover breast pumps! My friend gave me her PISA and then decided when I was done they might want more kids and took it back. So now I will need one!

How does the insurance thing work? I'm so new to private insurance so I have no idea. Do I call my insurance? Look online? Ask my dr? Etc.

Thanks ladies!

AmadorRose · October 2015

Tricare now covers pumps and is actually covering them back a certain time frame, though I'm not sure what the window is or what the fine print on it is. I know for myself, since I'll be full-time be it working or in school for as long as I'll breast feed, an electric pump is a must. If insurance hadn't covered it for me, I would've used one of my sisters and changed the tubing much like you did for your first.
It's been a long time since I've had regular insurance, but from what I can recall this seems like something you'd call the insurance company about or see if they detail your coverage online. Otherwise, if you carry the insurance you could ask coworkers who have had a baby recently...not sure if your husband would be comfortable asking around though

Good luck!

Monicagail1 · October 2015

Most insurance plans now must cover a breast pump as a piece of medical equipment due to the Affordable Care Act. Some plans may be exempt due to special circumstances. However you'll have to contact your plan to get info on the type covered, your out of pocket cost, and where you can purchase.

For example, my plan will cover the purchase of a double electric at a participating DME provider if I have a RX from my doctor. Or, it covers the rental of a hospital grade pump. But each plan may have different rules or places you can go.

NachosAndPeaches · October 2015

It's just private insurace we pay OOP for me and DS (DH has veterans insurance for free). No job! I'll google a bit. Should have probably done that before posting. No flames ladies!

Monicagail1 · October 2015

Also, FYI the PISA is an open system, and considered a one user pump. They don't recommend a multiple user scenario. Some pumps are closed systems made for multiple users, like the hospital grade Medela Symphony.

eastdurian · October 2015

I'd call your insurance, luckily they've been covering breast pumps for a couple years already so they should know what they're talking about. I had DD right when they started covering them on my plan so it was a little confusing, it seemed like nobody knew the right answer.

I know this time it's as easy as ordering it online through my insurance's approved medical retailer.

plus15pie · October 2015

I got my Medela breast pump in the mail this week free from my insurance company. I also received 10 extra bottles. I went to the website listed below and someone contacted me directly and handled all the insurance pAperwork. I just had to pick which one I wanted.

https://www.breastpumps.aeroflowinc.com

akb1125 · October 2015

I would start by calling your insurance company. My insurance company had a list of companies I could call and order the breast pump from. I called one of those companies, gave them my insurance info plus Drs info so they could confirm the pregnancy. Then they sent me the breast pump. I got a medela and it worked great.

pinottoparenthood · October 2015

Call your insurance company and ask them about it. Mine wasn't covered last time either :-(

jasmineahenderson · October 2015

AmadorRose said:
Tricare now covers pumps and is actually covering them back a certain time frame, though I'm not sure what the window is or what the fine print on it is. I know for myself, since I'll be full-time be it working or in school for as long as I'll breast feed, an electric pump is a must. If insurance hadn't covered it for me, I would've used one of my sisters and changed the tubing much like you did for your first.
It's been a long time since I've had regular insurance, but from what I can recall this seems like something you'd call the insurance company about or see if they detail your coverage online. Otherwise, if you carry the insurance you could ask coworkers who have had a baby recently...not sure if your husband would be comfortable asking around though

Good luck!

Seven months ago when I was in the market for a breast pump with my son TriCare only covered a manual pump. Has that changed?

NachosAndPeaches · October 2015

Monicagail1 said:

Also, FYI the PISA is an open system, and considered a one user pump. They don't recommend a multiple user scenario. Some pumps are closed systems made for multiple users, like the hospital grade Medela Symphony.

I know, but it was a good friend I trusted. And obviously used new tubing etc.

brie_and_almonds · October 2015

jasmineahenderson said:

AmadorRose said:
Tricare now covers pumps and is actually covering them back a certain time frame, though I'm not sure what the window is or what the fine print on it is. I know for myself, since I'll be full-time be it working or in school for as long as I'll breast feed, an electric pump is a must. If insurance hadn't covered it for me, I would've used one of my sisters and changed the tubing much like you did for your first.
It's been a long time since I've had regular insurance, but from what I can recall this seems like something you'd call the insurance company about or see if they detail your coverage online. Otherwise, if you carry the insurance you could ask coworkers who have had a baby recently...not sure if your husband would be comfortable asking around though

Good luck!
Seven months ago when I was in the market for a breast pump with my son TriCare only covered a manual pump. Has that changed?

You'll have to check to know for sure, but this has likely changed. I believe new laws went into effect shortly after my daughter was born (<3 years ago).

sprocketsngadgets · October 2015

Like people said, call your insurance. I got some bad info from another recent mom at work saying a pump wasn't covered so I didn't check. Luckily the lactation consultant at the hospital had dealt with my insurance a lot and knew she could go downstairs, grab a PISA and I could go home with it then and there free of charge. The hospital just did a direct charge to insurance. If not for that I would have used my friends with new tubing (she used it tops 10 times). Always best to check

AmadorRose · October 2015

jasmineahenderson said:

AmadorRose said:
Tricare now covers pumps and is actually covering them back a certain time frame, though I'm not sure what the window is or what the fine print on it is. I know for myself, since I'll be full-time be it working or in school for as long as I'll breast feed, an electric pump is a must. If insurance hadn't covered it for me, I would've used one of my sisters and changed the tubing much like you did for your first.
It's been a long time since I've had regular insurance, but from what I can recall this seems like something you'd call the insurance company about or see if they detail your coverage online. Otherwise, if you carry the insurance you could ask coworkers who have had a baby recently...not sure if your husband would be comfortable asking around though

Good luck!
Seven months ago when I was in the market for a breast pump with my son TriCare only covered a manual pump. Has that changed?

I know they won't cover a double electric pump unless your baby has health issues, is a premie, etc but I believe they will cover electric. If they don't, I'll buy used or pay for a new one because there's no way I'm going back to work full-time with a manual pump. I'm going to have to look it up, I guess.

mrstrax · October 2015

AmadorRose said:

jasmineahenderson said:

AmadorRose said:
Tricare now covers pumps and is actually covering them back a certain time frame, though I'm not sure what the window is or what the fine print on it is. I know for myself, since I'll be full-time be it working or in school for as long as I'll breast feed, an electric pump is a must. If insurance hadn't covered it for me, I would've used one of my sisters and changed the tubing much like you did for your first.
It's been a long time since I've had regular insurance, but from what I can recall this seems like something you'd call the insurance company about or see if they detail your coverage online. Otherwise, if you carry the insurance you could ask coworkers who have had a baby recently...not sure if your husband would be comfortable asking around though

Good luck!
Seven months ago when I was in the market for a breast pump with my son TriCare only covered a manual pump. Has that changed?
I know they won't cover a double electric pump unless your baby has health issues, is a premie, etc but I believe they will cover electric. If they don't, I'll buy used or pay for a new one because there's no way I'm going back to work full-time with a manual pump. I'm going to have to look it up, I guess.

Check if there is a hospital supply store in town too - my hospital has one and you can rent the hospital grade (and safe to share) pumps through them. I have no idea how insurance would work with that but its worth looking into to avoid a manual!

AmadorRose · October 2015

mrstrax said:

AmadorRose said:

jasmineahenderson said:

AmadorRose said:
Tricare now covers pumps and is actually covering them back a certain time frame, though I'm not sure what the window is or what the fine print on it is. I know for myself, since I'll be full-time be it working or in school for as long as I'll breast feed, an electric pump is a must. If insurance hadn't covered it for me, I would've used one of my sisters and changed the tubing much like you did for your first.
It's been a long time since I've had regular insurance, but from what I can recall this seems like something you'd call the insurance company about or see if they detail your coverage online. Otherwise, if you carry the insurance you could ask coworkers who have had a baby recently...not sure if your husband would be comfortable asking around though

Good luck!
Seven months ago when I was in the market for a breast pump with my son TriCare only covered a manual pump. Has that changed?
I know they won't cover a double electric pump unless your baby has health issues, is a premie, etc but I believe they will cover electric. If they don't, I'll buy used or pay for a new one because there's no way I'm going back to work full-time with a manual pump. I'm going to have to look it up, I guess.
Check if there is a hospital supply store in town too - my hospital has one and you can rent the hospital grade (and safe to share) pumps through them. I have no idea how insurance would work with that but its worth looking into to avoid a manual!

I plan on a few more after this LO so I figure I'm better off biting the bullet and buying one, maybe there's something similar to this that sells them? I'll definitely check it out.

pinottoparenthood · October 2015

If you end up having to buy one, we were able to use the registry discount on mine so that helped.

mrstrax · October 2015

@AmadorRose That's how we bought our pump. In 2014, I don't think our high deductible HSA plan reduced the price, but it counted toward the deductible, so it all worked out between the global prenatal fee, hospital delivery and then DH having his appendix out 6 weeks later.

MrsCayEye · October 2015

My insurance covered it with DS, but you couldn't order it until birth and they were always back ordered so I just bought one since I wanted and ended up needing one right away. BRU had the PISA on a great sale and they gave a free video monitor with it when I got mine, so keep your eyes peeled for a good deal.

geminioftwo · October 2015

My insurance covers it. I had to call them and ask what vendors they work with and went to the place to pick it up. They actually already gave me the pump and are doing all the insurance stuff behind the scenes. I got the Mendela In-Style tote. I did end up paying $50 because I upgraded from the one that was free. But I used the same with my prior pregnancy and it worked great. I was able to BF my son for 19 months (yeah this does mean he's still going at it :P ).

littleredx2 · October 2015

I have BCBS (TN) and called last week. They only cover $28 for a manual pump (my Medela manual cost me more than that). Sigh.

They do cover the full price of a double electric if baby has a NICU stay so I received one back in 2012 when DS2 was born a tad early. I tested it out with DS3 but it seemed the suction was lacking so I really need a new one or to call Medela and figure out if there is a fix.

Come on insurance, get it together. A manual pump will not cover it once I go back to work. And $28 is laughable.

melandyga · October 2015

Call your insurance. Mine told me to MAKE SURE I got a prescription for one before I left the hospital. The hospital gave me a list of agencies to call for one, we called the one the nurse recommended and were given several options. Of course, the told us there'd be a delay for the most expensive of the bunch. (We'd called and got the list, researched, then called back). However, we think they were just trying to talk us out of it because it came only a week later! I got a Medela pump in style and didn't pay a dollar!

Here's a bonus tip: fish tank tubing works well as replacement and it only costs $4!

pinottoparenthood · October 2015

littleredx2 said:

I have BCBS (TN) and called last week. They only cover $28 for a manual pump (my Medela manual cost me more than that). Sigh.

They do cover the full price of a double electric if baby has a NICU stay so I received one back in 2012 when DS2 was born a tad early. I tested it out with DS3 but it seemed the suction was lacking so I really need a new one or to call Medela and figure out if there is a fix.

Come on insurance, get it together. A manual pump will not cover it once I go back to work. And $28 is laughable.

Did you try replacing the parts, in particular the white membranes?

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