How to Get Your Insurance to Pay for Breast Pumps
Although breast pumps are covered under the Affordable Care Act, getting the one you want and finding out what your individual policy covers can be complicated (and frustrating) to deal with. Each plan may have different guidelines on the kind of breast pump that is covered in the policy, or if they reimburse after you buy it. In 2018, insurance provider Anthem cut its breast pump reimbursement in half, making it a lot harder for parents relying on insurance to get a quality breast pump.
Mom-to-be Gretchen Evans experienced this frustration—she'd placed a call to her insurance company, only to find out they didn't cover pump purchases, only breast pump rentals, which left her feeling "icky."
"The woman I was speaking with agreed with everything I was saying, but it was the policy of the company and out of her hands," Evans tells Parents. "She even stated she wouldn't be comfortable with the insurance option."
With all the things you need to prepare ahead of your baby's arrival, going back and forth with your insurance company can be less than appealing. Here's how the experts told us to make sure you get the most out of your insurance benefits.
Breast pump laws
The current healthcare law does cover breast pumps, explains Tina Sherman, campaign director for the Breastfeeding and Paid Leave Campaign at the women's advocacy organization MomsRising.
"Under the Affordable Care Act [ACA] breastfeeding moms are eligible to receive lactation support and breastfeeding equipment and supplies," she tells Parents.com. "Breastfeeding equipment is based on the recommendation of the woman's healthcare provider and may include but is not limited to: double electric breast pumps, including pump parts and maintenance, and breast milk storage supplies."
The problem is that insurance companies interpret this all different ways—some only cover certain brands or models, some require you to get them from an in-network "durable medical equipment supplier" (in other words, not at Target or BuyBuy Baby), some may allow you to submit for reimbursement after you buy it, and some require a prescription from your doctor.
In addition, when you can buy your pump varies, too—some make you wait until after your baby is born, even though that's a major hassle. Older plans written before the law, or "grandfathered," don't have to adhere to the ACA, although they still may offer some benefits.
The bottom line? You have to call to find out. "It's important to contact the individual plan in advance to verify any unique processes and requirements," Abbie Leibowitz, MD, chief medical officer, founder and president emeritus of West's Health Advocate Solutions, tells Parents. "Do not purchase a pump on your own without first confirming the preferred process with the plan, as this may disqualify you from being reimbursed." He advises calling rather than just reading what's online, as individual plans can vary.
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What to ask
If you're getting the runaround or are still confused, see if you have access to a health advocacy service through your insurer or your employer, Dr. Leibowitz suggests. They can help you sort it out. "Similarly, if you have health insurance through your employer, your human resources or benefits representative is a great resource," he says.
Also, talk to your doctor about your individual pumping needs, as this might help push through your pump coverage, especially if your insurance requires a prescription. "If you will be pumping often and require an electric pump, be sure the prescription indicates this to ensure you are covered with the most appropriate pump," Dr. Leibowitz says.
Picking a pump can be confusing—you want to make sure you have the right one, not just the one insurance says it will pay for.
"The type of pump you get depends not only on your needs, but on your body—breasts and nipples come in all shapes and sizes, and different pumps can be better with different supply levels," Sam Rudolph, mom and creator of the unique smart pump Babyation, tells Parents. "The pump that's best for you also depends on your lifestyle. I know some moms that are very happy with their manual pump because pumping isn't part of their daily or weekly routine. On the flip side, moms that hook themselves up to pumps multiple times each day have a different set of needs." Y
our doctor or a lactation consultant—whose services might also be covered by insurance—can help you decide.
OK, so what if you want a pump your plan doesn't cover? Check if you can be reimbursed up to the amount your plan will cover. If not, you might have other options.
"Beyond insurance, few moms know that they may be able to use pre-tax dollars," Melissa Gonzales, president of women's health at Myriad Genetics tells Parents. "Moms may be able to use their flexible spending account (FSA), health savings account (HSA) or health reimbursement account (HRA) to help cover the cost."
It's a lot of legwork to manage when you're trying to get ready for a new baby, but doing your research now may save you money on your pump later. Gonzales has a handy list of questions to ask your insurance company:
* What type of pump can I get (hospital-grade rental pump, double or single electric personal use, manual pump)? Do I have brand options?
* Do I have to get the "recommended" pump or can I choose to purchase one 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 breast pumps?
* If I have already obtained a breast pump, can I submit a claim for reimbursement?
* When can I get my breast pump—before or after giving birth?
* Where can I get my breast pump? Does it have to be from a designated place (an "in-network" provider) or can I choose where to get it?
* Will I need a prescription from my healthcare provider?
No matter which path you take, know that there are options available to you to get the breast pump that matches your needs. Do your research and plan ahead, so you know what your insurance covers (and doesn't cover) so that you have it figured out by the time your baby arrives.
Related: Baby Preparedness Finance Checklist
