I came home yesterday to find my new breast pump waiting on the front step. Although I have no use for it YET, I’m still excited about its arrival. One of the best parts? It was FREE! I paid $0.00 for a pump that retails for around $225.
Above: My new breast pump – Ameda’s Purely Yours Ultra
I’ve blogged about the Affordable Care Act before, so this post focuses strictly on breastfeeding provisions. As of August 1st, insurance companies are required to provide support to nursing mothers. This support includes covering the cost of lactation consultants and breast pumps. You don’t have to have any medical diagnosis – you just need to plan on breastfeeding your baby. Your coverage will start when your insurance policy renews – mine renewed October 1st, but some plans don’t renew until January 1st, 2013. When your plan renews, you will be entitled to this coverage.
Regardless of your political leanings and opinions on the Affordable Care Act, if you have health insurance, and are planning to breastfeed, it’s worth taking advantage of these new provisions. Here’s what I had to do to get my free pump. Obviously, every insurance company is different, but these are the basics:
1) You’re going to have to be patient and persistent about the process. It was by no means a nightmare, but because the legislation is still new, insurance companies don’t have it 100% figured out. Be prepared for different answers from different people.
2) I started by logging into my insurance company’s website (I have a Blue Cross/Blue Shield PPO product). Once I was on the website, I looked for their list of approved durable medical equipment suppliers. I think most insurers will require you to purchase your pump from this type of company. A durable medical equipment supplier sells everything from prosthetic limbs to diabetic testing supplies.
3) Once I found the list of approved suppliers (there were ten or so provided), I looked through each company’s online catalog to see which ones actually carried breast pumps. Out of all the suppliers listed, only one company carried breast pumps. The supplier I used was a company called Edgepark.
4) I looked through the offerings, and then checked everything out on Amazon so I could read reviews and compare pumps. Your insurance should cover a double electric pump – not just a cheapo manual one. Edgepark’s options were limited to those manufactured by Hygeia and Ameda. I ended up picking the Ameda Purely Yours Ultra. It retails for around $225 on Amazon, and comes with the pump, tote, extra flanges, insulated milk cooler, car adapter, pumping pad, and an adapter so I can switch to manual pumping if desired.
5) Once I selected a pump, I added it to my cart and checked out. Because Edgepark is a durable medical equipment supplier, it deals mostly with insurance companies. The check out process was lengthy – I had to provide all my insurance information, as well as contact information for my OBGYN, but it wasn’t especially difficult. You DO NOT have to provide a credit card or any other payment details. After filling in all the boxes, I submitted my order.
6) Then you wait a little while. The supplier contacts your insurance company and figures out all the billing information. After checking with my insurance company, Edgepark called me back and let me know that there was no co-pay or deductible, and I owed no money. A few days later, the pump showed up at my door.
Side note: I actually ordered my pump twice. The first time, I tried ordering it in August. Edgepark called me, and I was told my insurance company wouldn’t approve the pump purchase until I’d actually delivered a baby. They said they’d keep all the information on file, but I had to call the company the day I delivered and they’d ship it out then. I passed this information along to a girlfriend at work, and when Edgepark called her about the order, they said she could call two weeks before her EDD, and they’d approve the pump purchase then – she wouldn’t have to wait until the baby actually arrived. So, two weeks before my EDD I called back and asked them to resubmit the claim. The lady I spoke with on the phone didn’t think it would work until I’d actually had the baby, but she offered to submit it to the billing department anyway. It must have worked, because the pump showed up at my doorstep. This is what I mean about getting different answers from different people – be prepared for a little confusion.
That’s it! Although it took a little detective work to figure out how to order it, was worth it for a $200 savings.
Have you gotten a free breast pump from your insurance company? Was it a difficult process?
[Edit 11/9 – A few important additions that our great commenters have reminded me about: 1) Your coverage will not begin until your policy renews for the first time AFTER 8/1/12. If you’ve called your insurance company recently, and didn’t like the answer they gave you about coverage, ask when your policy renewed. If it hasn’t renewed since 8/1/12, your coverage may increase when it does renew. 2) As an alternative to covering the cost of a double electric pump, some companies instead choose to cover the cost of renting a hospital grade pump – this is an awesome option and worth checking into. 3) Some insurance plans were “grandfathered” – they aren’t required to meet ACA provisions. If you have one of these plans, you’re out of luck, at least for now. 4) Every insurance policy is different – my experience may not be your experience (but I hope it is!). ]
Pumping & Increasing Milk Supply part 4 of 11
1. Increasing Your Milk Supply by Checklists2. Pumping Up the Volume by Mrs. Bee
3. My Pumping System by mrs. wagon
4. Don't Pay for a Breast Pump Until You Read This by Mrs. Tricycle
5. More milk, more milk, more milk! by Mrs. Hopscotch
6. Building up a Breastmilk Freezer Stash by mrs. wagon
7. Exclusive Pumping vs. Breastfeeding by Mrs. Bee
8. How To Clean a Medela Pump by Mrs. Bee
9. My Pumping, Freezing, and Defrosting Strategy by Mrs. Bee
10. Project Milk by Mrs. Bee
11. Feeding and Storing Expressed Breastmilk by Checklists
grapefruit / 4582 posts
ACA is so cool. I’m so happy mamas are starting to get reasonable coverage!!
clementine / 957 posts
This is amazing information. Thank you!!!
cherry / 141 posts
Great information!! I’m bookmarking this!
grapefruit / 4235 posts
my insurance will only cover the cost of a manual pump OR the cost of renting a hospital-grade pump. At least that’s what they told me the second time i called and asked about it. Sigh.
I did put a pump on my registry, but we’ll see if I’ll need it….
pear / 1672 posts
This is getting pinned. Thank you, thank you!!
grapefruit / 4669 posts
Hmm, that’s really interesting! I have BCBS PPO as well and the only info we could get is that if we buy a breast pump, it will go toward our deductible but won’t be free unless that is met? I want a free pump! I’m glad you got yours.
pineapple / 12053 posts
hm, i wonder if things will change for me january 1 as i called recently and the person i spoke with said it wasn’t covered and that’s what i found when i dug deeper since i’m “grandfathered” into my plan. i’ll hold out since LO isn’t due to make her arrival until mid january.
blogger / wonderful cherry / 21628 posts
This is great!
coconut / 8234 posts
@tororojo: Did you call BCBS? I have BCBS PPO as well. I called and asked specifically and they told me they cover 100%.
Getting my pump was easy! BCBS told me I needed a prescription, but in the end I didn’t need it, just had to provide my midwife’s name and contact information. I got a Medela Freestyle for Free.99
blogger / pear / 1964 posts
@dagret: you’re right – some companies are choosing to cover rental costs instead – but that might be even better – hospital grade pumps are supposed to be awesome. You get new flanges and tubing and stuff, so I think that eliminates the grossness/germ factor of a “used” pump.
persimmon / 1479 posts
Mine only covered a manual pump,which really suprised me (we have GREAT insurance).
blogger / pear / 1964 posts
@birdofafeather: that’s a nasty exception – a few plans were grandfathered in, and therefore don’t have to meet ACA provisions – but as soon as they raise your co-pays or deductables (I think) they loose their grandfathered status and then DO have to follow ACA…. I’m not an expert, but I think that’s how it works?
blogger / pear / 1964 posts
@mrsmenow: really? Has your plan renewed since August 1st? If not, then maybe your benefits will improve once it does renew. Did you have the option of renting a hospital pump? That’s one way they can meet the mandate without covering a double electric.
blogger / pear / 1964 posts
@tororojo: I don’t pay any kind of deductable…so maybe that’s the difference between our plans?
blogger / wonderful cherry / 21616 posts
wow this is cool!! Wouldn’t have worked for me a year ago I take it
bummer.
GOLD / eggplant / 11517 posts
Awesome post!!! Thanks for sharing.
GOLD / eggplant / 11517 posts
@Mrs. Tricycle: @dagret: Also, just as an FYI, hospital grade pumps don’t have any breastmilk/fluid going into the actual pump itself, so there is no cross-contamination issues once you replace the hoses and outer parts.
blogger / pomegranate / 3201 posts
This is amazing! I wish this was in effect when I got my pump. I wonder if the reimburse… probably not.
coffee bean / 29 posts
Thanks for the info! I have Blue Cross/Blue Shield PPO too and they said they don’t cover breast pumps. So I ended up getting a manual one. Maybe I should check again since ours renews by January.
pomegranate / 3272 posts
I literally just contacted BCBS about this yesterday and was told that my coverage doesn’t include this. We renew in January so I will have to call back then!
honeydew / 7687 posts
I spent SO much time on the phone with United Healthcare about this. Basically, they don’t have to cover it until January when our new year starts – but even if they did, there are no suppliers that sell breast pumps for the price that they reimburse (with the exception of the single breast Swing) so I was SOL. But glad that many are able to benefit!
blogger / eggplant / 11551 posts
I just finished open enrollment so I was reading all the benefits, and they cover a rental hospital grade breast pump and/or a personal electric double-pump… I’m so taking advantage of this. My coverage renews on 1/1/13, but my baby isn’t due until end of February so it all works out. Thanks for the informative post!!
grapefruit / 4400 posts
@scg00387: I have UHC, too! I haven’t tried calling yet… what was the price they are willing to reimburse for? And the Swing looks like it gets decent reviews on Amazon!
guest
My eldest son was a preemie – 26 weeks, emergency c-section. The day after he was born the lactation consultant came to my hospital room, pump in hand, to give me a demonstration. It was free thanks to my insurance, and I didn’t have to do any work to track it down. I used it for 15 months. I’m now using it again for my second son – 38 weeks, VBAC. It is an Ameda double electric and shows no sign of calling it quits. Which is a good thing; I need it to last at least eight more months.
GOLD / cantaloupe / 6581 posts
Thank you SO much for posting this! I’m going to go look at my insurance right now!
honeydew / 7687 posts
@habesbabe OMG I hope you have better luck than I did. I probably spent 4 hours talking to them & back and forth. I know they have different plans, so you might have a different experience! I wanted a double pump. Basically there was only one DME in the area that sold breast pumps and accepted insurance, period. That DME, Avira?? I think? was contracted with UHC that they only received $40 per pump, regardless of type. So, the DME would only give out the single Swing even if your prescription was for a double (and gave me some long speech about how they were ‘losing money at that’ or some BS). And, we haven’t hit our high deductible yet so since it is before 1/12, I would’ve paid out of pocket for the $40 anyways and it would’ve just been applied to our deductible. So, I bought a Medela PIS with our HSA. I have no idea if that is helpful at all, it was such an annoying process with different people telling me different things. I finally resorted to just asking everything on their myuhc website so I had a record and could show them what the other person had said.
persimmon / 1180 posts
I can’t seem to find what companies my insurance will allow. I have CareFirst PPO. Can anyone help? I know that they’ll cover it, but I have to use an approved provider.
pomegranate / 3053 posts
That’s awesome. It’s too late for me but I’m glad that it’s out there for new moms now. I’ll be passing this message onto my pregnant friends for sure!
guest
If you obtain insurance through your employer, you should check on the status of the plan (i.e. grandfathered or non-grandfathered). ACA does not apply to grandfathered health plans. Plans can lose their grandfathered status if they make certain significant changes that reduce benefits or increase costs.
cantaloupe / 6164 posts
So awesome for you! Considering we have a $5000 deductible, nothing is ever free for us.
guest
Thanks for posting about your experience with this. I just started making inquiries this week. I have a UHC PPO. I’m very persistent about bureaucracy so I feel hopeful@
kiwi / 511 posts
My littlest was born at the end of May (my insurance re-ups every Jan 1) and I have BC/BS PPO and my pump was covered. Every plan is different even if everyone has BC/BS it doesn’t mean that every company has a plan that covers a pump. What a company decides to have covered will affect the premium due (meaning how much a company and the employee pays). So the coverage or lack there of is not a BC/BS thing it is your employers thing.
That being said for my company’s plan I had to have a RX written for one but there had to be a reason not just that I was able to get a doctor to write it, and it was actually my pediatrian that wrote the script. My plan covered a hospital grade rental for about 6 weeks (the timing is kind of fuzzy at the moment) and when I returned it I called the rental company they sent me a UPS lable to return the pump to them and with that lable came the new pump (I had a choice of 2 and I picked the Medela Advance double electric and like it well enough. I didn’t notice a real differenc between that one and the Medela Symphony that I left the hospital with). I did meet a deductible first but that was easy and part of my specific plan.
I am not necessarily a fan of insurance companies and the bureaucracy, but I wanted to point out that it is not really the insurance companies that have said no to coverage. It is the companies (i.e. employers) that provide the coverage. An insurance company will cover just about anything provided the premium is right, and for employers to keep the premium to something they can cover (with the employee contribution) they will elect not to have certain things covered. It isn’t personal it is business.
pomelo / 5331 posts
It might be even later than Jan. 1 for some people — it’s the first renewal date after Aug. 1 2012. Which for me, happens to be June 1, 2013. Which is pretty useless considering I’m due in February
pomegranate / 3414 posts
My policy doesn’t renew until January 1st, however I have checked with my insurance. They will only cover upto $200 so if the pump I chose cost more than that I’d have to pay the difference. They did however say that they would cover the cost of a pump once effective even though DS was born this past September so check with your insurance company if you don’t need a pump right away but will need one in the future. I had a pump from DD so I didn’t need to get a new one but may consider it after the coverage kicks in.
grapefruit / 4278 posts
I have a BCBS PPO and they will only cover the cost or rental or a manual pump AND you need a prescription… I was pretty bummed about that. I’m borrowing a pump from a friend, and that arrangement is working out great, but I really wanted to have my own.
blogger / pear / 1964 posts
@ladyfingers: Good point – first renewal AFTER 8/1/12.
blogger / nectarine / 2010 posts
When my plan renewed I could get a rental pump from a covered DME. So I researched the DMEs my plan covers and the closest one to me (in VA) was in MA. And they didn’t ship. Sooooo, it was totally useless coverage.
pomelo / 5331 posts
@Mrs. Tricycle: I should add, great post!
grapefruit / 4400 posts
@scg00387: OH LORD that sounds like a nightmare. I’ll have to do some more investigating. I did find a PDF of DMEs in network with UHC and the one Mrs. Tricycle mention (Edgepark) was one of them!
grapefruit / 4669 posts
@photojane: I feel you on the $5,000 deductible! Kind of makes you feel screwed with a Feb due date, huh?
Maybe next time I’ll try to scheme the timing out better!
honeydew / 7687 posts
@habesbabe yeah, I was not thrilled to say the least
I wish that I could’ve just rented through December and then sorted it out in January when they would’ve covered it 100% to order one from out of state potentially (like Edgepark) but we’re also moving out of state after the baby is born so I just gave up haha. I hope you have way better luck than I do!!
apple seed / 1 posts
@Mrs. Tricycle: Would you be able to tell me which one you ordered through edgepark. I believe there are three different order items for the ameda purely yours breast pump on their site. Thank you so much for blogging about it. I contacted my insurance and they said it would be covered. I have Blue Cross Blue Shields and said I can order through edgepark.
bananas / 9973 posts
Thanks for this super helpful post! I have BcBs PPO as well, through DHs work but I don’t work so I will have to find out about when I can try to get this. But this is awesome if they even cover a portion, since I’ve heard most ppl don’t don’t like to buy breast pumps for shower gifts!
coffee bean / 29 posts
Very interesting article! I will echo what another poster said – having a baby qualifies you for a change in status, and you can change your contributions to your Flexible Spending Account or Health Savings Account (or start one if you weren’t already contributing). I had my baby in Feb. of this year so we weren’t eligible for the ACA’s new provisions, but we did cover the cost of a hospital-grade rental with my FSA! So glad we had that.
GOLD / wonderful apricot / 22646 posts
Def sent this post to my BFF who’s expecting her lil girl in Feb!
We have Cigna HMO and found out that we wouldn’t get any coverage this year unless our LO was a preemie!
Next year I think there’s partial coverage, but since we’re due any day, we wanted to get something in advance. Thankfully we lucked out with some coupons, price matching, giftcard and only paid $185 for a brand new Medela Freestyle!
blogger / pear / 1964 posts
@lwebb: Those numbers are crazy, huh? I just looked back through my order and the pump was item number EW17085. Good luck!
kiwi / 673 posts
I think every plan is going to be a little different in what it covers. For example, ours does cover *something* for breast pumps, but only up to $50. Basically, we can get a $50 reimbursement for the cost of any pump (our plan just renewed, not sure if it was grandfathered). Everyone should definitely call their insurance to see what it covered, but don’t automatically get your hopes up that you’ll get a free double electric or even coverage for a hospital grade rental.
guest
Update: I am on UHC PPO and I placed my order on Nov 9th. I just got notice that I will receive my pump tomorrow. Wow! lightening fast!
guest
You are AMAZING! I just checked my UHC and through Edgepark I was able to order a Medela dual pump in shoulder bag which I think is the Medela pump-in-style tote that I wanted originally! I may have to wait until 2 weeks before like you did, but I really appreciate your help!
guest
Update: My Ameda Naturally Yours pump just got here!
guest
Oh. Thanks for that review.
These are awesome. I think I’ll grab one as a gift to my sister this coming Christmas!
apricot / 301 posts
Thanks so much for this post!
Congrats again on the baby and I hope you are covering well!
I too have BCBS and was told I qualify on January 1st for a free pump. I’ve also contacted Edgepark and was wondering why you chose the Ameda over the Hygeia? They also said the Medela advanced basic was available, but that they couldn’t advertise it on the site. Any insight would be greatly appreciated!
guest
I just clicked your link for Edgepark and it says in big bold red letters, *IMPORTANT NOTICE* due to a nationwide shortage on breastpumps they are no longer taking orders…you can then opt to be put on an email list to be notified when they have more….wow!! Hopefully when I need it, it’ll be available!
guest
My insurance company requires a prescription, as well as going through specified merchants.
blogger / pear / 1964 posts
@lovebird: I picked the Ameda because it was a brand I had heard of and it got good reviews on Amazon (and at the time I think it had the highest retail price – I equated $$$ with best). That doesn’t mean the other options are bad.
@T. Mintz – Wow! That’s crazy! I guess the insurance changes are making breast pumps more accessiable!
guest
Just want to clarify some on this as I work for a dme company in rochester ny. When calling your insurance company about the pumps, most customer service reps will quickly tell you they are covered only when medically necessary, which is part of their old coverage criteria. Ask to speak with a supervisor. They will tell you they are covered in full, not even subject to a deductible or c/p as the pumps are now mandatory. They used to only cover manuals unless proven by your doc that it wasn’t working. No script needed, no c/p, no deductible! Yayyy
585-227-8750 call if you need a supplier!
guest
Cigna told me no coverage without a specific diagnosis! Going back to work didn’t count–also, it was $190 with Cigna, and they wouldn’t guarantee coverage. So I could receive the pump, Cigna could review it, deny it, and send me another bill! Not worth the trouble…
guest
Anyone purchase from Edgepark lately using Blue Cross Blue Shield? I called, but not eligible until I am 30 days out from my EDD. They said that I would get the Medela, but the image looks so 1990s (with my first baby, i had used one that was about that old). Here is the link, https://www.edgepark.com/images/faq/breastpumps/important_bp_info_chart3.pdf. Does anyone know which model was actually received or options currently available
guest
I have Cigna PPO (no maternity coverage) and it seems to have worked. My EDD is March 3rd. I called them last year to get info and they gave me the number of their provider Carecentrix to call and place the order. I called Carecentrix and they were super helpful; told me to get a prescription from my doctor and call 30 days before my EDD. I called back last week and submitted the order right away (no prescription needed even though I had it), took all my info down and a few hours later they called me back and asked me to choose between a Playtex and an Ameda pump. It hasn’t actually arrived but it should be in transit.
Ladies, I still listed a pump with my registry which I got. I still wanted to have one in case the insurance one didn’t go through. Now I’ll probably just return the one I got as a gift.
blogger / pear / 1964 posts
@Lily I got the Ameda from Edgepark (I got to pick from three or four options). No complaints. A good way to compare the two is to read the reviews on Amazon. That’s how I decided which one to buy — Edgepark/my insurance let me pick.
@Paula Glad it worked for you!!
guest
They told me I am not covered because I am part of a group plan.
guest
I work for a medical supply company that is enrolled with BC/BS. I have had several women contact me requesting a breast pump, which I would be more than happy to provide if we weren’t running into issues with the insurance company! They keep reiterating to us that the pumps are not covered simply for “convenience” purposes, only if they are medically necessary. This is what puts up the road block. When we bill for a medical products, we have to submit a diagnosis code that justifies the medical necessity.
Can anyone who has received a pump paid for by their insurance tell me what their doctor diagnosed them with? This would be very helpful to several women who are currently trying to obtain a breast pump!
kiwi / 511 posts
@BARAUJO I had BC/BS last year (May 2012) and they were covered by my company policy so before the Aff.Care Act kicked in. But my son’s Pedi had to write a prescription for the pump, and it was for flat nipples and latch issues. He never did latch so I pumped for 9.5 months. It covered the rental on the Medela Symphony for about 2 months and then when I returned that I was sent the Medela Advance. I actually got the Advance and then returned the Symphony.
Hope this helps.
guest
@MRS.MAVEN Thank you for the response. That’s exactly the impression we are under; that their has to be a medical reason why the infant is unable to feed directly from the breast. I was just curious if anyone has obtained one without having to be diagnosed with a feeding “problem”.
guest
Anyone have any experience with getting lactation consultations covered by insurance?
guest
BARAUJO, That is simply inaccurate information… According to the affordable care act It’s covered simply for being pregnant.. You do not need a medical reason for a breast pump. The only thing that needs to be done is order it through a durable medical supply company that takes your insurance (in my case blue cross and blue shield) You have to wait the 30 days before your EDD. You give them your insurance info and your doctors info, you doctor simply verifies your due date. The only way a script is needed is when you are renting a hospital grade pump… here is the info directly from blue cross as you can see: https://member.carefirst.com/wps/portal/Member/MemberPopupTab?WCM_GLOBAL_CONTEXT=/wcmwps/wcm/connect/Content-Member/CareFirst/MemberPortal/PlanSummaries/Tab/psPrevSvcsAdults other than that the affordable care act MANDATES a double electric pump the only thing it does not specify is brands
guest
So I just got off the phone with Edgepark and they are denying me the Ameda because my doctor won’t write a script. Did everyone here have a prescription?
guest
I’m soooo happpy I did a search on this topic and found your blog! I live in NY and called about 15 DMEs from a list provided by BCSBS and none of them carry breast pumps! Needless to say I began to get discouraged. I just called Edgepark and my order is being processed. EDD is 4/20/13. Thank you so much for posting this information.
guest
Hello ladies, I work for a DME in upstate NY that does supply breastpumps to new moms. BCBS is by far the easiest to obtain a breast pump through. BCBS of the Rochester area will pay $178.50 towards the purchase of your choice of pump, but only through a participating DME. You DO have to have a prescription, but we are happy to help you with that part. Pumps cannot be dispensed until after your baby is born, and BCBS will not pay for the accessories or bags. Those are considered “upgrades”, but are fairly reasonable. I have been distributing pumps since December of last year, and I can help make the process quick and easy , call 585-377-5350.
pea / 13 posts
Thank you so much for this information, great post!
@Trixie – I have Aetna PPO and was able to get six visits with a lactation consultant covered 100%. I first went to Aetna’s website to search for a lactation consultant that is under my plan. There were none listed in a 50 mile radius of my zip code. I called customer service and since there was a deficiency of providers, they said I was allowed to use one of my choice and would be reimbursed. I had to call some other number at Aetna to work out the details, but eventually I got a letter in the mail from the insurance company confirming the 100% coverage. This took about two days to accomplish so totally worth it.
guest
I have BCBS and it’s different for everyone depending upon their specific policy. Just because it’s covered 100% for one bcbs member doesn’t mean it’s that way for everyone and just because it doesn’t cover milk storage bags and other supplies for one person doesn’t mean it’s that way for everyone. My bcbs policy covers a breast pump up to $350 and It’s covered 90% as long as my deductible has been met. It covers manual pumps 100 % and also covers all supplies such as storage bags, parts etc 100% It also covers visits with lactation consultant. Be sure to check with your particular plan because they are all different.
guest
Just wanted to say thank you soooooo much for posting this. You are a God send. I have BCBS PPO also and was getting absolutely no where with them whenever I called. Everyone I spoke with/emailed said that it was covered 100 percent but no one had a clue about actually getting it. It was actually a hospital lactation specialist who told there were only certain companies you could order them from. So I Googled and came across your page. Seeing as we had similar insurance, I went for it (the worst the could tell me was that they couldn’t process the order, right?). I called Monday to give them my info, the fax was waiting at my dr’s office this afternoon (dr faxed it back), and this evening I received a confirmation email stating that the pump had been shipped and should arrive in 2 to 3 business days! Thank you so much!
guest
Hi everyone,
Just happened to come across this post, and as someone who works in the DME field, I thought I’d share some info.
Coverage will vary based upon your insurance provider and your specific contract. Just because you and a friend both have Blue Cross does not mean you’ll both have the same coverage. Deductibles, co-pays and requirements for coverage of certain items vary by contract. Also, keep in mind that almost all insurance providers apply DME services against the deductible. So, if you have an unmet deductible, you may have to pay for a portion, or all, of the item. (Even if you only pay $10-20 at the doctor’s office, you may still have a deductible. Office visits are usually exempt from the deductible.) If you don’t have a deductible or if it’s met, you may still have a co-pay. Co-pays, if applicable, will be a percentage of the insurance’s approved reimbursement amount for the item. DME co-pays are never a flat fee.
Also keep in mind that it is becoming less frequent for insurances to pay for breast pumps just because you had a child. Some insurances will only cover them in extreme circumstances, such as the baby being born premature, or the baby being separated from the mother in the NICU. For example, forms of Medicaid only pay for breast pumps when the baby is separated from the mother. That means if you can hold the baby in your arms, they will not pay. Or if you request the pump after the baby leaves the NICU, they will also deny coverage. However, some better insurances like Blue Cross, will have less strict mandates. I’ve seen Blue Cross cover for simple complications like engorgement or feeding complications (e.g. baby cannot latch on), but that is not very common.
Finally, there are detailed prescription requirements that are set by each insurance provider. The things that EVERY insurance requires are: Patient name, date, product prescribed and diagnosis, along with the doctor’s signature. Each insurance may opt to require additional information. For example, Blue Cross of MI now requires duration of need and the gender of the patient, and Medicaid requires the patient’s birthdate and Medicaid ID number or social security number.
If you think you got your item without a prescription, think again — your provider probably called to request one on your behalf. Insurances will not pay without a proper prescription, and most providers won’t even attempt to bill the item without it because it’s a waste of resources.
If you have questions, call ahead and ask. If you have questions about deductible or copay, or where to go for service, call your insurance provider. However, if you have questions about what information is needed on the prescription, call the company that will be providing the item. You would think the insurance company would be able to tell you what is required on the prescription, but that isn’t always the case. Insurance companies have different departments for customer calls and provider calls, and a lot of times the people that help customers don’t know as much as they should about the provider side of things where the billing happens. Far too often I have to deal with patients who have already done the right thing by calling their insurance ahead of time, but were misinformed and let to believe their prescription was valid.
And finally, your insurance may restrict which kind you can get. Manual vs electric, single vs dual. Also, some providers only carry a certain brand to control cost. If you’re looking for a specific model, you may have to call around.
Best of luck to all the soon-to-be and new mothers out there!
blogger / pear / 1964 posts
@Jeremy – Based on my understanding, the Affordable Care Act changed this: “Also keep in mind that it is becoming less frequent for insurances to pay for breast pumps just because you had a child.”
I think, at this point, the opposite is now true. I received a “free” breast pump simply because I had a child — coverage that was not included a year ago, but was now mandated under the Affordable Care Act.
guest
Thank you for this how to. I was able to get a Medela pump through my insurance an I love Edgepark now . Great service they took care of everything an the pump was covered 100%. Thing was when I contacted insurance myself they told me it would only be covered 80% so I am happy
guest
i actually had the same experience which was amazing but i went through Aeroflow Healthcare and did not have to wait until my EDD. they did everything for me the only thing i had to do was get a RX from my doctor and they shipped it to my house. the whole process took less than a week!
guest
As of August 2013 blue cross will not let edgepark ship any of the three pumps they offer to Tennessee. I’m 8.5 months pregnant and now the hunt continues
guest
I have Cigna and just called their medical equipment supplier Carecentrix (60 days before my due date as I had previously been told).. I told them I had a prescription (your doc should wrote this for you regardless of any issues). I planned to fax it over the following day but forgot. My Ameda Purely Yours double electronic pump arrived 3 days later…I still haven’t gotten around o faxing the prescription!!! Amazing! Good luck everyone.
guest
Is there anything that I can do to get BCBS to cover me for a breast pump? I will be needing one soon. Due in less than a month. I called and they told me that my plan did not supply them. Could my Dr. have one issued after birth for engorgement/difficult feeding? Or is it just simply not covered no matter the circumstance? Any input would be greatly appreciated!
guest
Emily, I’m very surprised that your plan doesn’t cover breast pumps. You may want to call and check again. The Affordable Care Act stated that insurances must provide breast pumps to new moms at no charge. I bill breast pumps every day at work and have yet to see a BCBS plan that doesn’t cover them in full. A diagnosis like engorgement or feeding problems won’t help and it might actually hinder the process. If I try to bill using one of those diagnoses, the computer system will stop me and tell me the diagnosis is no good. The preferred diagnosis for BCBS is v24.1, which is something along the lines of supervision of pregnancy, but most docs just write lactating mom. (Make sure your script has a diagnosis, by the way.) Anyhow, call BCBS again and ask why your breast pump isn’t covered under the Affordable Care Act. I helped a customer recently that didn’t even have DME coverage and they were still covered, and they even had a huge deductible that wasn’t met. From my understanding, BCBS and BCN are covering them in full for all new moms, limited to one per year. This is in Michigan though… not sure if it may be different in other areas.
guest
I called them again today right before I put my comment on here. That is actually what set me out trying to find an answer. I asked BCBS why it was not covered and if there were any circumstances that would make me quality. Her response was “I am sorry, there isn’t. Your employer would have to have it added to the policy.” I live in Missouri and BCBS if of Illinois. I would like to think that there is something that I can throw at them to get one covered, but it just seems to be my luck that I can’t figure anything out. Thank you for writing back on this, I am still not sure if there is anything else that I can do.
kiwi / 511 posts
@Emily did your doctor write you prescription for it or did you just call and ask for it covered? I know when mine was covered (BCBS but prior to Obamacare) the process was started by my pediatrician and she wrote a prescription for it.
Check in with the office manager at your OB’s office I bet they are used to these calls and can be more help. Also you don’t necessarily need a pump prior to giving birth. I pumped elusively because my son and I had latch issues, but I had a pump in the hospital that left with me and then when I was ready to go back to work I called the medical equipment place and they overnighted a pump to me (they had two I could pick from I went with the Medela Advanced and liked it) and then once I had that pump, I put a return sticker on the hospital one and dropped it at the UPS store. It was pretty easy.
guest
I just simply called and asked if they were covered on my plan. I go in for an appointment tomorrow, I will discuss it with my Drs and see if they can have one issued. I was just hoping to find out if it was even an option so that I can be prepared to purchase one if I can’t get it covered. It kind of sounds like I might not even be able to tell for sure if I can until LO arrives. Are there any references or sites that anyone is aware of that I might be able to share or at least study myself if they still refuse to cover it? If Drs order does not work, is it a lost cause?
guest
A prescription will not help get it covered if Blue across says it’s not. A prescription will prove medical necessity on a covered item, but for a non covered item the prescription does nothing. (Except allow the provider to waive sales tax… At least in MI.) Blue Cross decides what is covered and what is not, and if they decide a breast pump is not covered, a prescription won’t change their mind. Emily, my best advice would be to have a DME provider check your benefits and see if they find out anything different. If they also say Blue Cross won’t cover it, then you’ll have no other option but to pay out of pocket. Hope this helps!
guest
Ok, thank you!
guest
I work in a specialty unit at Highmark BCBS and we get multiple calls every day for expecting mothers looking for breast pumps. There is a lot of great information in these comments already but I do want to touch on two major things:
As of October 2012, if you have BCBS of any state and are looking to get a pump from a mail order company such as Edgepark or Byram, that company must participate with the BCBS of the state that the pump is being delivered to. If you live in New Jersey but the plan offered by your employer is BCBS of Michigan, and you want to get a pump from Edgepark, Edgepark must participate with BCBS of NJ. Be very careful when looking for any DME supplies through mail order.
Also, just because your insurance company tells you you get a “free” breast pump, if you have not met your deductible, it is not “free” No matter who you get a pump from or what your insurance is, if you have not met your deductible, nothing is “free” Even then some people have co-insurance where the insurance will pay for 80% of a service after you have met your deductible, you then are responsible for the remaining 20%.
guest
I work for a brick and mortar, family owned DME company in Michigan. I bill breast pumps every single day. I also call each and every insurance to inquire about breast pump benefits. In accordance with the Affordable Care Act that went into effect January 2013, 99% of all insurances tell me breast pumps are covered in full — AND NOT SUBJECT TO COPAY OR DEDUCTIBLE. What the last commenter said is incorrect — if the breast pump were subject to deductible and your deductible isn’t met, then you wouldn’t be getting a breast pump at no cost. Every once in a while when an insurance tells me it’s subject to deductible and copay, I ask about the ACA. At that point, the usually agree with me and say that the policy probably hadn’t been updated yet. It’s a law people…
guest
Thank u so much for this piece and letting other moms know about your experience I contacted the edgepark company as u had and got my pump 4 days later thank u very much and best of wishes to u all!
guest
Thank you thank you thank you! I couldn’t find a DME supplier that had the breastpump I wanted (the Pump in Style by Medela,) but one of your commenters mentioned Aeroflow, and they have it! It is covered 100% by my BCBS PPO! Thanks again!!
guest
Just a note for everyone- I have Blue Cross Blue Shield Texas (started January 1, 2014 thanks to the Affordable Healthcare Act). All I had to do was submit for an order form from Edgepark Medical- they told me they’d email me my order form 1 month from my due date, and they did! I filled it out, they called my dr for a prescription, and only 5 days from filling out my order form the brand new, $450 Medela breastpump was delivered to my doorstep at 0 cost to me! I’m really impressed with their customer service and wanted to tell everyone who has BCBSTX that this is a great route to go and doesn’t involve having to call the insurance company and possibly get someone who doesn’t know about the process, like I did the first time I called.
guest
Hello your website url: http://www.hellobee.com/2012/11/08/dont-pay-for-a-breast-pump-until-you-read-this/ seems to be redirecting
to a completely different web page when I click the home-page link.
You may want to have this checked.
guest
Note, that now you have to be within 30 days of your due date to order a pump.
guest
Hi I saw all comments here, I live in NY & found that terrific store called A Medical Supply & they did all the work for me & was thrilled to see my medela pump in style covered by insurance delivered within days giving in my dr. Prescription to there office, there number is 845-783-6678 I found them online at amedsupplies.com
guest
Thanks for sharing! I was having a heck of a time finding an “in-network” medical equipment supplier who would ship to Ohio. Edgepark actually ships to all states and offers great pump options compared to other “in-network” suppliers I found.
guest
I was told by BCBS that they would cover my breast pump from edge park. I received a bill a year and a half later stating BCBS would not cover the pump (even thought called twice and was told by 2 different people it would be covered). I could not appeal it becaise it was over a year. So my “free” bump was not free at all. I ended up having to pay for it