Getting Breastfeeding Help and Breast Pumps through your Insurance

on February 04, 2014 in Affordable Health Care (ACA), Breast Pumps Covered, Breastfeeding, Breastfeeding Help Covered

You may know that the Affordable Care Act, or ACA for short, now mandates that mothers covered with private insurance are entitled to a breastfeeding support, as well as breast feeding supplies, including breast pumps. This was signed into law in 2010. Most insurance plans began implementing this coverage on or after August 2012.

 

Most insurance companies are required to cover lactation visits. Nearly all insurance carriers cover lactation counseling without a co-pay.  So you should not hesitate to reach out for experienced eyes and hands-on help if you need it! If you are unaware of local lactation consultants, IBCLC’s are recommended.  An IBCLC is an International Board Certified Lactation Consultant who has taken course work, has many hours of experience, has passed an exam and must continue with her learning by attending many hours of educational programs to keep up to date. If you need to locate a local IBCLC, visit ILCA.org and scroll down the home page and follow the instructions to find the names of IBCLC’s in your area.  You can ask your insurance company how many sessions are covered under your policy.

 

Getting a pump from your insurance company can be  a bit complicated, but here is some information that can help you.  While every plan is different, know that many insurance carriers are still establishing their coverage policies.  Unfortunately, there is a great deal of variation in what sorts of pumps are covered, and how they are covered. Because the law’s        recommendations aren’t very specific, coverage varies from Health Company to Health Company. Most plans require women to obtain the pumps from their designated vendors, which may or may not offer the        pump that a woman hopes for and that means a mother usually can’t buy a pump at retail and submit a receipt for reimbursement.  Some cover purchase of  cheap manual pumps which may not be effective enough especially for mothers returning to the workplace.  Also, know that there is no co-pay for  your breast pump as long as you deal with an in-network provider.  Your insurance company will either list these preferred contracted providers on their website, or you can call them for the list.   Going out-of-network will usually result in out of pocket expenses and less recourse if you are unsatisfied.

 

Unfortunately, about a third of insurance plans are “grandfathered” out of having to comply with the ACA.  Grandfathered out plans are those that were purchased before March 23, 2010. These plans have a  grandfathered status and don’t have to follow the ACA rules and regulations or offer the same benefits, rights and protections as new plans.  But if the insurance        carrier changes any language in its plan, they must then comply with coverage stated in the ACA.       

 

When speaking with your insurance company, talk to them about what you want and need. Some companies offer a double collection electric pump within two months after giving birth, but may offer only a hand pump after two months post partum and up to a year after delivery. Be sure to ask your provider what your “ordering window” is, that is when you are eligible to place your order and when it ends. Mothers are only eligible for a pump every 3 years, but if you need a new collection kit or other parts before that   time, you may also be eligible for these.

 

Most insurance carriers refuse to cover hospital- grade rental pumps, which may be needed soon after birth to help mothers establish adequate milk flow because of a sick or premature baby or breastfeeding complications, like low milk supply.  If your insurance carrier does cover one, a written prescription from your baby’s doctor and pre-authorization is necessary.        For mothers who need a hospital grade pump, the few insurance companies who will cover a standard rental breast pumps up to the value of the purchase price.   In some of these cases, depending on how long the        pump is needed, the insurance carrier could actually purchase the breast pump for the mother. The breast pumps must be purchased through a medical equipment company that the insurance contracts with.

 

While you are pregnant, try and educate yourself on  the many pumps on the market.  In “The Nursing Mother’s Companion”, I have included a thorough review of most all pumps on the market.  It includes which pumps get good, mixed or poor reviews by both mothers, lactation consultants and myself. It is not too early to contact your insurance company to see  what pumps their Durable Medical Equipment Companies (DME’s) offer to nursing mothers before your baby comes.  In this way, you will know which  pumps to decline and which ones are higher quality pumps.

 

Most insurance companies will require you to get your pump from an in-networking DME company that they contract with.  One recent review of insurance  companies revealed few of them allow mothers to upgrade to a better pump, even if the mother is  willing to pay the difference.  Some insurance  companies without a contracted DME may be flexible if the pump you want isn’t available, letting you choose another pump or        sometimes even reimbursing your purchase from a retail store.  Again, you need to ask for what you want! Because pump benefits varies from company to company, you will need to contact your insurance  provider, using the number on back of your insurance  card. The Women’s Law Center that can help you if  your plan is denying you benefits, unless they are grandfathered out.  They can be        reached at 1-866-PILL4US or email pill4us@nwlc.org.

 

Unfortunately, coverage for lactation services and breast pumps does not cover all women who receive  Medicaid or WIC (Women, Infants, and Children Food utrition Services) benefits. Twenty-nine states are complying with the Affordable Health Care Act to provide services and equipment to nursing mothers, but that means that twenty-one states have opted out.  You can see if your state’s WIC programs are complying with the Affordable Health Care Act or not at  http://www.advisory.com/daily-briefing/resources/primers/medicaidmap

 

But mothers who have WIC benefits may be eligible for a loaner electric pump through WIC if they are having breastfeeding problems, have a premature or sick newborn or are returning to school or work.  WIC Programs may also have lactation consultants on staff.