Did you know that you can probably get a breast pump through insurance and not have to pay the cost of a really great breast pump?
The breast pump is a sign of freedom for modern moms. For some, it’s an essential tool that allows women to continue working while continuing to breastfeed. Even if you only need a small pump to prevent engorgement and leaking while you transition your baby from breastfeeding to bottle feeding, not having a high-quality breast pump is a hardship.
The problem is that the best breast pumps are expensive. Most mothers need a double electric pump that is durable, quiet and efficient, but it’s difficult to squeeze those pumps into your budget. Before you start saving your pennies or decide to go with a lower-quality pump that fits your budget, consider the option of securing a quality pump through your health insurance. While this doesn’t work out for every new mother, it is something to look into before you spend money out of pocket for a pump.
How to Get a Breast Pump Through Insurance if You Have Obamacare
If you have an insurance plan from the Affordable Care Act Marketplace, you’re in luck. Insurance companies offering plans through the Marketplace are required to cover the cost of a breast pump in addition to lactation support and counseling if needed. The catch is that the insurance company gets to decide whether they give you access to a rental breast pump or a new pump that you can keep. If you receive a rental, then the insurance company determines how long you are allowed to keep the pump.
If you’re given a pump to keep, the insurance company gets to determine which pump you receive. They can give you a cheap manual pump with limited features, so don’t get excited until you find out what type of pump your insurance company will approve. Many insurance companies will follow the recommendations of your doctor, so talk openly with your doctor about the type of pump that will work best for you and your baby.
It can take time to apply for breast pump coverage and actually receive the breast pump, so make sure to start the process before your baby is born. You will need to contact your insurance company to determine what is covered, and you may need to secure pre-authorization or a recommendation from your doctor.
Some plans require you to buy through a specific medical supply company, and they may not have the pump that you need in stock. The earlier you start the process, the more likely you are to receive your pump before your baby is born.
The Obamacare Exception – Grandfathered Plans
There is one more catch to the Obamacare breast pump dilemma. If you secured your insurance plan prior to March 23, 2010, you may have a plan that was grandfathered into the Affordable Care Act. That means that your provider may not have to live up to all of the Obamacare standards, even if your carrier is now governed by the Marketplace rules.
While some carriers will still offer the breast pump, they may not have to do so. The only way to find out is to call your insurance company and ask.
Is Your Breast Pump a Medical Need?
If your baby was born premature or has other medical needs that make a breast pump an essential element of their care, most insurance companies will approve the coverage as a medical necessity. If you find out that your insurance will only offer a manual pump, then this is your chance to request a double electric pump that is sufficient for the care of your baby. If your plan isn’t monitored by the Affordable Care Act and your provider doesn’t normally provide coverage for breast pumps, talk to your doctor about submitting your baby’s medical information to see if you can get a breast pump covered for medical needs.
Easy Ways to Find Insurance-Covered Breast Pumps
The fastest way to determine whether your insurance company will cover a breast pump is to call them and ask. If you don’t want to do that or just want to get an idea of which pumps may be covered, you can perform a simple search through the Medela insurance-covered pump finder. This will limit your search to pumps found on the Medela website, but it can give you some idea of which pumps are available based on your state of residence and your insurance carrier.
If you’re interested in Aeroflow breast pumps, they will actually work with your insurance company and doctor on your behalf. The process starts when you fill out an insurance breast pump form on their website. They take only basic contact and insurance information that is needed to determine your benefits and petition for coverage. They then contact your insurance company verify your benefits before coordinating with your doctor to secure the needed authorization or recommendation. You will then receive a breast pump in accordance with your coverage.
If you’re interested in other types of breast pumps, look the company up to see if they have a program similar to these. This is a convenient way to allow professionals to deal with your insurance company to determine which pumps are approved by your plan.
What to Expect from Your Insurance Company
Even if you allow a breast pump service to communicate with your insurance carrier on your behalf, it’s best to call your insurance company first. You want to ask questions about the coverage of pumps and other breastfeeding resources through your plan, and then you should request that they send the information to you in writing. This will stop the company from later reducing or refusing your benefits.
Here are some questions that you want to ask:
- Does your plan allow for breast pump rental or a brand new pump?
- Are electric pumps approved through your plan?
- Are you limited to specific brands?
- What other limitations should you be aware of when picking a pump?
- Do you need to buy your pump from a certain retailer or medical supply company?
- Do you need pre-authorization or recommendation from your doctor?
- When can you expect to receive the pump?
If your insurance company only allows breast pump rentals, you may not receive the pump until after your baby is born. This reduces the cost for your insurance company because they will only pay for the pump while it is in active use. If you’re authorized to receive a brand new pump to keep, then the insurance company may allow you to order and receive the pump before your baby’s birth because they aren’t paying rental fees while waiting for your birth.