After a fairly smooth experience feeding my first four babies, my last baby threw me into a noose (as they usually do) when it came to care. Born five weeks earlier, she refused to nurse. Personally, it was important for me to provide her with breast milk, so I decided to join the world of exclusive pumping (EP).
After a few weeks of pumping around the clock with my traditional double electric wall pump – one of many types breast pumps available – while I cared for my newborn, four other children who had to travel back and forth to school every day, and my husband worked outside the home, I knew I needed help. I decided to consider buying Alviewireless, pump without arms it would allow me to express milk while taking care of my mom’s other responsibilities. One problem? Elvie was very expensive. So I turned to a health insurance plan to see if I could get a breast pump through insurance – for those who are pregnant formula deficiency may be interested in the same – and that’s what I learned along the way.
Is it possible to get a breast pump through insurance?
You can not only get a breast pump through insurance, but also legally, your health insurance plan has to cover it for free, free of charge. All health insurance plans – including Medicaid – should cover breast pumps by law. The only exceptions are a few grandfather’s planswhich should not offer coverage, although many still do.
“Thanks to the Affordable Care Act (ACA), health insurance companies now provide coverage for a wide range of women’s health services, including breast pumping and supplies, usually free for you,” explains Natasha Cantrell, director of individual and family affairs. . sale for E-health.
Are breast pumps with insurance free?
Some breast pumps will be 100% free through your health insurance plan. However, there may be rules as to what type of breast pump allows you to get your insurance, such as manual or electric, or only certain brands. Also, some plans may allow you to rent a pump instead of storing it.
Other types of health insurance plans may allow you to purchase your own breast pump and then reimburse you for the allotted amount. For example, my insurance plan would fully cover the traditional pump, but because I wanted Elvie, I bought the pump myself, sent a receipt to my insurance plan, and they sent me a check for the amount allotted to them – which ended up half the cost I paid for pump.
How to get a breast pump through insurance
While all of this probably sounds great, you’re probably wondering: how do you actually get a breast pump through insurance? You can take a few steps:
Step 1: Find out what your insurance covers.
Each insurance plan will be different from what exactly it covers, so you want to check the features of your plan. If you have an account or app online, check out the guide in the “Pregnancy” or “Breastfeeding” section. I managed to find my information very easily in the guide to benefits online. If you can’t find it online, you can also just call the insurance number.
Some insurance plans may also contact you if you tell them about your pregnancy. For example, after enrolling in a health insurance program under her health insurance plan, mother of five Gretchen Bosio received a phone call from the care coordinator when she was 32 weeks pregnant to arrange breastfeeding. After confirming that the pump she wanted was on the approved list, she was ready. “The pump arrived in the mail a week later,” Bosio says. “Super easy! I was so grateful! ”
If you have commercial insurance, you can also get a more expensive pump at a lower price, explains Jason Kanzana, CEO Accelerator. “In these cases, you can“ upgrade ”using your insurance to help subsidize the cost of a more expensive pump, such as a nasal breast pump or a pump that comes with a bag and other accessories,” he says. In essence, the price of the pump is reduced by the amount that the insurance company pays the breast pump supplier and you will be responsible for the difference.
Step 2: Follow the steps of your plan to apply for the pump.
Again, each plan will be different, so it’s important to clarify the coverage rules in your specific plan. For example, some plans may require a doctor’s order or prior authorization, some may only cover certain brands or types of pumps, and others will force you to apply for a pump through a third-party website.
For example, found Erin Heger, a mother of two Edgepark, a third-party organization that works with insurance companies through Google. She plugged in her insurance information, chose the Spectra 9, and all. “It was completely covered by insurance and the process was very simple,” she explains. “I was sent a pump a few weeks later.”
Kanzana adds that searching the network of a breast pump supplier with durable medical equipment (DME) can help parents in the application process for a pump. For example, Acelleron checks insurance information and may even request a prescription from your doctor on your behalf, so you don’t need to call insurance or a doctor. (If you already have a recipe, you just upload it to the site.)
Using a third-party provider can also be helpful because you can apply for a pump at any time during pregnancy if you have a prescription, although the company will not be able to physically ship the pump until the insurance plan approves it. For example, you can submit your information in the second trimester so that it is done and there is no to-do list, but if your insurance plan stipulates that you cannot get the pump until you deliver, the company must follow these rules.
Step 3: Follow any specific rules.
Speaking of rules, sometimes getting a breast pump through insurance can be as simple as filling out a form online, but it’s also important to know that some insurance plans may have certain rules regarding breast pumps. For example, Katie Waite, who has five children, was entitled to a new pump with each pregnancy – provided she was 18 months old – but found that her insurance plan also had a harsh warning: she could not apply for a pump . until she gave birth.
When I was pregnant first and called health insurance, a woman on the other end of the line told me I couldn’t order it until the baby was born, “just in case the baby matures” and well, that week it’s pretty led me to a puddle on the floor, ”Waite notes. “Later I called and complained and I was told it wasn’t the way I should have said it, but it was politics.”
Again, the rules for each insurance plan will be different, but Cantrell recommends contact your insurance company for details at the end of the second or third trimester. Typically, Canzano adds that most insurances cover one breast pump per pregnancy, but there are some insurance plans and Medicaid plans that allow only one pump for a certain number of years and in very rare cases only one pump for life.
Which brands of breast pumps are covered by the insurance?
Unfortunately, some brands of breast pumps may not be covered by insurance in full or covered at all. So if you have a certain type of pump, be sure to check with your insurance provider to see if it is covered. Also, consider whether they offer a compensation option that you could take advantage of, as I did.
“Now Elvie’s portable breast pumps Willow create the most noise, despite the fact that they are rarely covered by insurance due to the high price, ”says Canzano.
However, the good news is that there are many more affordable models of breast pumps available, so you can find another option that is right for you. “Breast pumps Medela and Spectra are probably the two most popular and well-known brands outside the wearable category, which make up the bulk of the breast pump market,” he adds.
Others often ask questions about breast pumps:
The most important step in getting a breast pump through your insurance is to clarify the coverage rules in your plan, but there are also some other things that can be helpful.
How long do you need to take the pump after the baby is born?
Kanzana notes that in general most plans allow you to apply for a pump up to 12 months after the baby is born. However, again, this may be different, so be sure to check.
What applies to Medicaid breast pumps?
While most Medicaid plans nationwide cover breastfeeding, Cannes adds that there are some government Medicaid plans that do not accept federal money and therefore do not have to follow the recommendations of ACA’s preventive health services.
“These plans usually cover breastfeeding only when there is a medical need, which means the baby is unable to start breastfeeding due to a condition such as prematurity or an oral defect,” he explains. Again, you will need to check your specific plan to learn the rules.
What if you don’t have insurance?
Kanzana explains that if you don’t have health insurance, you can:
- Pay out of pocket for the pump.
- Pay with an FSA or HSA card.
- Contact the WIC clinic to find out if you are eligible to rent or get a pump for free, and what other services may be available to you.
- This not recommended that you are using a breast pump that was used by another person; the only way to safely do this is through an authorized supplier to make sure it has been cleaned and sterilized properly.
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