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 grandfather in 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.
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.
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.
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:
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.
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.
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.