Requesting a breast pump… Does that sound like a crazy idea?

Requesting a Breast Pump from Your Health Insurance Carrier

Breastfeeding can be a wonderful and beautiful experience for both mother and baby, but sometimes, life can complicate the breastfeeding process. Perhaps a baby has trouble latching (often the case with premature babies), or a mom needs to return to work before her little one is weaned. In this case, breast pumps can play a key role in achieving success in breastfeeding. While these valuable tools were costly to obtain in the past—often running more than $300 out of pocket—there is now another option. The recently passed Affordable Care Act (ACA) will now require health insurance carriers to provide breast pumps to pregnant and nursing mothers.

How do you go about asking your health insurance carrier for your benefits and requesting a breast pump?

It is important that you understand the provisions in your own private health insurance plan in order to gain maximum benefits. Here are some tips on how to approach your insurance provider.

  1. Understand your plan and the benefits of the ACA. Do your research. Before you call your insurer’s customer service department and ask about a breast pump, you will need to confirm your eligibility. Some policies are ineligible and therefore are exempt from coverage.
  2. Be prepared with a list of questions when calling your health insurance carrier. It is important to ask about the specifics of the coverage within your plan. This may help you set reasonable expectations of your benefits.
    • Am I required to have a prescription in order to get a pump? Who do I get the prescription from, my OB/GYN or my Personal Care Physcian? What does it need to say? Are specific codes required?
    • What type of pump would be covered under my plan?
    • Would it be a manual expression pump or an electric pump?
    • Where would I get the pumps? Would I purchase it and provide receipt for reimbursement?
    • Would I use a network vendor or Direct Medical Equipment (DME) supplier? Would it be delivered to my house?
    • Am I covered for out of network benefits? If so, can I get a pump from an out of network DME?
    • When can I order my breast pump? Would it be before or after the birth of my child(ren)?
    • Are lactation consultant services and visits covered in my policy?
    • Are there any restrictions such as the number of visits allowed with the lactation consultant?
    • If I need a hospital grade pump, how would I get one?
    • Would my accessories be covered, such as a car charger, battery packs, milk storage bags, etc?
    • Could I choose to upgrade to an electric pump if I was allotted a manual pump? Is there a cost and how much?
    • If there is co-pay, can I pay it with my Health Savings Account/Flexible Spending Account?
    • What brands of pumps can I choose from?
  3. Document all conversations. It’s important that you take notes during your conversations with your carrier, paying special attention to details like the name of the person you spoke with, date and time, and what method of communication-phone or email. Since the implementation of the ACA and its benefits are fairly new for the health industry, this will help you address any potential discrepancies.
  4. Be confident. These are your rights and benefits entitled to you by the law. Don’t be afraid to ask questions!