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How to Get a Breast Pump with Insurance
It can be a challenging task to order. In this article we walk through helpful tips to order your pump.
How to get a breast pump: the 101 guide
Have you ever tried to order a breast pump from your insurance company? We have. And you’d think you were trying to figure out how to crack the code on the Riemann Hypothesis. But whether you have received a pump from insurance before or not, we’ll try to simplify it for you (I mean, if one can simplify bureaucracy).
In 2010, The Affordable Care Act was passed into law, and -- good news -- there are two parts that support breast/chestfeeding parents. One is that you can have a private space and enough time in your workday to feed your kiddo or pump (the law technically only covers hourly employees, but most places of employment have that as a policy and make it apply to all lactating parents). The other is that insurers need to provide a breast pump and other lactation support to those that want it, at 100% coverage. Bad news: if you had your policy in place before 2010, your insurance company can decide to be jerks and opt to grandfatherin no breast/chestfeeding support. (Wow!)
Don’t get us wrong, we’re super thankful that feeding kiddos human milk was thought of and the fact that people who may not have had access to a breast pump now do, but like a lot of legislation (and the world of insurance), things can get confusing quickly.
A breast pump is durable medical equipment
Even though you can simply pick one up at the store, a pump is considered by insurance as “durable medical equipment.” And in order for insurers to cover that type of equipment, more than likely you’ll need a prescription. Not just any place can bill a medical claim, so you need to contact your insurance company’s medical equipment distributor or supplier. There are times when you can purchase a pump and receive a reimbursement from your insurance company -- but it depends on your insurance company, policy, and sometimes the medical equipment supplier.
You might not get to choose any breast pump you want
The Affordable Care Act (ACA) is great in that it has language to support breast/chestfeeding parents, but what isn’t so great (or maybe is great...again, confusing) is that there’s a lot of flexibility. The minimum pump required by federal law is a handheld manual pump (from some experience, it feels sort of like a glorified suction cup). Also, to add to the confusion, different states have different laws. And if the state law offers more coverage than the federal one, then that’s the law that trumps (and vice versa). We know … it’s a lot. But stay with us! Obviously, we’d like to see an absolutely amazing, deluxe, double electric pump on the list of what’s available to you. So here are the steps to find out how to get the best pump your insurance allows.
Where to Start
Talk to your medical provider
Ask the person who will be writing out the prescription for your breast pump (if your insurance requires that), if they’ll specify what needs you might have in the prescription. If you’re planning on pumping often, a double electric pump -- like the newest Pump In Style(R) with MaxFlowTM from Medela! -- might be best for you. If you’re planning on pumping very minimally -- maybe that handheld one is best. You can ask your provider to specify in the prescription what your needs are, and your insurance company will be more likely to cover your needs with a specific prescription order.
Start asking your insurance company questions early on in your pregnancy (there’s enough to remember toward your third trimester). And honestly, this process can take you several hours or more to get done. Ask questions like:
At what stage in pregnancy do you allow for a pump to be ordered (this can vary greatly depending on your insurance company and plan)?
What type of paperwork do I need to complete a claim?
Do I need a prescription?
What type of pump do you cover?
Do you cover a double electric pump?
Do you cover a hospital-grade pump, or the rental of one?
Are there certain models or brands that you cover?
Can I purchase the pump I want and get reimbursed?
What dollar amount will you go up to, and what paperwork do I need for that?
Will I need the billing code?
Do you cover other items, such as milk storage bags or bottles?
If you go through a durable medical equipment distributor or supplier, which ones do you go through, and what is their contact information?
Get an prescription (yes, you probably need a prescription)
Some plans require a prescription for you to order your insurance breast pump. Your medical provider will need to write on the prescription your estimated due date. Some insurance companies won’t send you a pump until you hit that date, (or you are at a specific point in your pregnancy) so be aware of that.
Supplier or distributor?
If your insurance company goes through a supplier or distributor, contact them next (most insurance companies will direct you there anyway). This way, you can talk to the people that are supplying the products. Often, they have more answers on how and what you’re able to order based on your insurance policy and usually they have less red tape to sort through — and their goal is to provide customer service and supply your needs.
If there is more than one supplier or distributor, be sure to contact all of them. They supply different pumps and have different rules. Some of the distributors policies and customer service are way better than others. It’s worth the second or third call.
They’ll ask what insurance company you have and what your plan is. Also, some insurance companies have a 3rd party verification company (remember what I said about simplifying bureaucracy?), and you might need to know who that is so the supplier can determine what pumps are available to you (ask your insurance company who that is).
Ask what type of models are available. Most suppliers will have a website where you can look through different options.
Once you have that all settled, you can order your pump. Be aware that there are different policies for insurance companies and suppliers. Also, different states have different laws in place. Ask when they will process the order and when they can send you the pump (or if you need to pick it up, and when you can do that).
Some policies and distributors will not cover a pump until you give birth, and some will cover it within 30 days of your baby’s estimated arrival date...and then that varies too.
Some exciting and helpful news
We are excited to tell you that our friends at Medela are launching their newest Insurance Concierge service through The Moms’ Room, which allows you to simply let Medela know you’d like a Medela breast pump through your insurance benefit, and Medela will do ALL the work above for you so you can have your covered breast pump shipped to you (at the time your benefit allows) and billed back to your insurance without the hassle -- and you get text messages along the way keeping you up to date on your order! You can check “breast pump” off your To-Do list early, and know that a pump will arrive as soon as your insurance allows! It’s that easy!
Again, insurance, laws, and parenthood...it can all be tricky and confusing. But you’ve got this. You’ve got all of this. You’re a parent — and that my friend, is just one more thing that makes you amazing.