I recently spent a weekend with my friend, who is expecting a baby girl in July, plan for her baby registry. One of the baby essentials that came up for discussion was the breastpump.
Like many newly pregnant moms, she didn’t realize that under the Affordable Care Act (ACA). which was signed into law in 2010, many insurance plans are now required to provide breastfeeding support and supplies at free of charge.
This new coverage has gone into effect with many health plans on or after August 1, 2012, so if you’re a newly expecting parent and want to learn more, read on to see how this can potentially save you hundreds of dollars. This applies not just with a breastpump but also potentially lactation consultant services.
To make it easy, I’ve broken it down for you by steps, and I’ve provided helpful external references from various sites such as Medela.
Step 1: You’ll want to contact your health care provider because every plan is different.
When it comes to which breastpumps are covered and how they are covered, it will vary by plans. You’ll want to speak with your insurance provider to understand the scope of your coverage and available benefits. The same goes for lactation consultants.
KEY TIP: I spoke with an insurance broker who shared that this would fall under your health plan’s durable medical equipment. Always call your provider directly to understand the full benefits, which are approved, and how much they will pay. The main thing is you’ll need to go with an in-network provider or manufacturer for your breastfeeding support and supplies.
A Real Mom Story…
A recent new mom shared that all she did was:
- Called her insurance company, United Health Care, to find out who their in-network vendors were
- Looked up the vendors online to see which breastpumps were available through her insurance. In her case, United Health Care, had 3 or 4 vendors, and each vendor provided different pumps, so she researched each pump to see which one she wanted to go with.
- Called the vendor, spoke to an operator, who took her insurance info, address, OB info, etc. The vendor contacted her insurance and doctor’s office to get proof of birth and other necessary info.
- She received the pump within a week. No charge, all covered by insurance.
KEY TIP: Some plans may not allow the breastpump to be shipped until the baby is born, but you can provide the vendor with the information to have it approved so once the child is born, they can ship it immediately.
Step 2: Have your questions ready before speaking with your health care provider. Know what to ask first.
Like I always say, things can get overwhelming very quickly when planning for parenthood, so it’s important to have a list of questions ready when you speak with your insurance company.
Pumps My Insurance Provider Covers
- What type of pump can I get?
- Do I have brand options? (hospital-grade rental pump, double or single electric personal-use, battery or manual pump, a Medela pump)
- Do I have to get the “recommended” pump or can I choose to purchase one (aka “out-of-network”) and submit the receipt for reimbursement?
- If yes, what amount will I be reimbursed? Is there a dollar limit on coverage for breastpumps?
- If I have already obtained a breastpump, can I submit a claim for reimbursement?
- Do I have to get the breastpump (or lactation visits) approved first?
Acquiring My Pump
- When can I get my breastpump? Before giving birth? After the birth of my child(ren)?
- Where can I get my breastpump? Does it have to be from a designated place (aka “in-network” provider) or can I choose where to get it?
- Is there a limit on the number of visits with a lactation consultant?
- Where can I receive lactation counseling services?
- Are there approved in-network providers?
- Can I get reimbursed if I use a lactation counselor out-of-network?
Pump Required for Medical Necessity
- Do I have a rental pump option? Do I need a prescription for proof of medical necessity?
KEY TIP: For more information, read tips from Medela on how to communicate with your insurance provider,
Step 3: Research which breastpumps and services are approved and best for you.
Every breastfeeding mom’s needs will be different, so it’s important to not just rely on what might be recommended to you by friends, but for you to also do the research.
KEY TIP: Medela actually has a great online quiz to help breastfeeding mom’s identify which type of breastpump will work best!
Did you know about this new ACA health care before for women? If so, what has been your experience like?
P.S. Here’s the latest Parenting Quote of The Week from miss vu – something we all can be reminded of whether parents or not.