Hellobee

I’m also excited about the breast-bump coverage. I’m at a loss for filing the claim though.

Do I buy it retail out of pocket, get a drs note and then submit a manual claim to ins company?

Researching options now…

@MRSJYW – Most insurance carriers are stating that you will have to get the breast pump from a Durable Medical Equipment provider… not from a retail store. You will have to check with your insurance provider to see what DME provider to use. You’ll also have to check on the doctor’s not… not sure if that will be required either.

I’m thrilled about it. My husband has a pre-existing condition (diabetes). Through the years, we’ve had to jump through hoops to make sure his medication and doctor’s bills were covered. At one point, my insurance wouldn’t cover his diabetes until a year and three months after I started working there. Some months it came down to food or insulin, because his insulin was $60 a bottle and he needs 3-4 bottles a month. We made too much to qualify for assistance but not enough that it was easy to pay the market rate.

I’ll step off my soapbox now.

I like this post and it’s factual perspective I too was following closely and yesterday morning I woke up saying, “I just had a dream that all aspects of the ACA were upheld”. (Ok, if I’m dreaming about the SCOTUS I’m a true geek!) About an hour later they issued the ruling and I was left wondering how I knew before it was issued.

These changes sound nice. I’ll definitely be looking into getting a breast pump when I’m pregnant.

While some of these may be an incidental benefit to me, I’m greatly saddened that the biggest tax raise and biggest expansion of government in the history of our country has gained more traction. I would much rather my children live in a freer country where there are more opportunities to succeed.

Wow – this is great information! Thank you for letting us know. The cost of a breast pump is no small thing (not to mention the other very important screenings, immunizations, etc.). I’ll definitely be looking into this more.

It’s also worth pointing out that none of these “benefits” are “free.” They are paid for by higher premiums (and almost certainly, eventually, higher taxes).

It’s also worth asking: I did not breastfeed my baby. No one helped me pay for formula. Why should I pay for someone to breastfeed?

@chicagowife: actually the government does help pay for formula. IF you qualify. I know many family members who had assistance from the state to pay for formula.

I’m bummed that in a moment of first time mom desperation I purchased a pump from Amazon instead of going to a local medical equipment shop. sigh.

@regberadaisy: Right, but as I read the post above, now breastpumps are covered even if you’re high income. But no mention of formula. Thanks for the clarification though!

I am really thrilled about the pre-existing condition part of this. I have family members (actually myself included) who put off testing for a genetic condition that we may have that requires incredibly expensive treatment monthly when you reach a certain point. The problem was that once you have that diagnosis good luck getting insurance. At $10k a month you would be bankrupt within a year but with out it probably dead within two. What a choice…

Papa Jumper has insurance through FEHB – Federal Employee Health Benefits, since he’s a Federal Employee.

Most of these changes took effect for us in 2011, though I can tell you that our premium increased *drastically*. Our current premium is close to what we pay each month for our mortgage — so these “benefits” certainly came at a huge cost.

So, for instance, we no longer have a co-pay for any well visits or for Baby Jumpers immunizations. I didn’t have a co-pay or co-insurance for my GD testing, either. But, we now pay a few extra hundred per month for our benefits AND our co-insurance increased from $500/family to $3600/family. We’re told that premiums are most likely going to increase 1.5-3% for 2013 benefits — and this is while Papa Jumper has been on a pay freeze for the last three years. So, our cost of living is drastically increasing… while his pay isn’t.

I’d MUCH rather pay the $20 co-pay for those services than the now thousands per years it’s costing us.

It’s my understanding that your insurance company doesn’t have to cover the breast pump (and other things) unless they change your policy in some way. I was asking about this recently and someone who worked on the legislation told me there is a grandfathering provision that will preclude coverage for a lot of nursing moms. I was thoroughly confused by her response, so don’t quote me on it. Definitely worth a call to your insurance company after the deadline to see what support you may be able to receive.

@Mrs. Stroller – I meant to do some additional research on the grandfathering provision, too. Here’s a PDF with some insight from the gov’t about grandfathering plans: US Gov’t Grandfathered Plans From what I can tell, plans won’t stay grandfathered forever. If your insurance company ever raises your deductible or increases your co-payments beyond an allowed amount, it will lose its grandfathered status.

It will be interesting to see how different insurance companies implement the breast pump legislation. This is Aetna’s take on it

@Mrs. Jump Rope – I’ll be interested to see what happens to our premiums when this takes effect. I haven’t noticed anything yet, but maybe it’s down the road.

It’s fascinating how one piece of legislation impacts so many people in different ways!

Just as an FYI – I called my own insurance company this morning (Excellus Blue Cross – I’m under Excellus BluePPO), and they don’t even have a clue about coverage yet. I found a PDF online that says breast pumps were going to be covered under my plan, and the customer service people hadn’t yet seen the same PDF (updated yesterday). I ended up having to e-mail them the document so they could see what I was talking about.

Moral of the story – this is going to be one of those things where patience is a virtue.

@Mrs. Jump Rope: Interesting. My husband and I are both federal employees and have seen very little change in our FEHB premiums. We’re currently each on an individual plan but will be switching to a single family plan when our daughter is born in a couple months. I was looking at the premiums recently and while it will increase to have a family plan, the increase was a fairly reasonable ~$80/month. It probably depends a lot on which plan you choose, since there are many FEHB options.

I know it’s a bitter pill to swallow sometimes, but preventative care costs do decrease healthcare costs in the long term. The cost of folic acid vs neural tube defects. The cost of a breast bump vs diabetes. Immunization vs. care for the disease. So it might take a temporary investment in up front costs, but if we can really combat some of these diseases before they start, we can address rising premiums in the future. The US current system is one of the last efficient funded systems, partly because we prefer to spend way more on treating diseases than preventing them. Of course when you decide to emphasize preventative care, you can’t just ignore people who already are sick, so costs do go up. But not nearly as much as they would in the long term. Additionally, the idea behind the ACA is that when everyone is required to have insurance in 2014, the extra market influx will create competition and prices will go down. That hasn’t happened yet. So no, nothing’s “free” but paying for these will be cheaper than paying for the diseases they prevent in the future.

The ACA has already saved my little family thousands. We went back on our parent’s insurance when we were in graduate school because it was little/no-cost under their plans and a good chunk of our budget under the school’s plan. It was doubly needed because I was diagnosed with a chronic bladder condition during that time. I would hate to think how much more we would have had to spend without it!

Thanks SO much for the info about the breast pumps. I had no idea! I’m calling my insurance company as soon as we switch plans next month!

@sgr523: Very interesting, indeed!

Papa Jumper took the position in 2009. We were given a huge book to choose insurance plans from, and chose a more expensive plan that covered fertility testing. So, right off the bat, we were paying a lot for coverage, which was OK with us, since it covered virtually everything. At the time, we did not have co-insurance OR a deductible. We are under a family plan, too.

In 2010, our premium increased slightly and we had a $500 deductible.

In 2011, our premium slightly increased. We had a $500 deductible and $1500 coinsurance.

In 2012, our premium increased again and now have a $500 deductible and $3600 co-insurance.

I’m not sure where the miscommunication lies. We’ve always been given the option of changing our insurance plan during open enrollment, but have never done so because we were unaware of the changes in our plans. I can tell you that Papa Jumper doesn’t receive any communication about the changes in plans from his HR department, and our insurance company doesn’t send us any correspondence, either.. so we’re left in the dark until a medical claim is processed and we get a bill.

Now that we’re aware of these communication issues, I stay super on top of our coverage and plans — including what deductibles have been met and so forth.

We plan on researching insurance plan options and hopefully switching during open enrollment this fall.

Here’s an article about the FEHB increased premium rates:
http://federaldaily.com/articles/2011/09/27/opm-says-average-fehbp-premium-to-rise-3.8-percent.aspx

@Mrs. Jump Rope: That sucks! Insurance companies really need reigned in. Once, I had a plan with a $1600 deductible. That was when I was a full-time volunteer with the Jesuit Volunteer Corps and made $1000 a year. *facepalm*

I have Humana HMO through my employer and when I first signed up for the special pregnancy program asked about breast pump coverage since it wasn’t covered during my last pregnancy and I hoped they had changed this. I was informed by the nurse that I spoke with about the provision in the ACA regarding breast pumps, unfortunately she had no clue as to how, when or if my actual policy would be affected (our new plan year starts on Jan 1 each year). She said she would mark that I inquired about this in my file but when I last spoke with her she didn’t mention it again. As I already have a pump from my last pregnancy I am not too worried although I was hoping to be able to get a better pump since I had output issues last time I pumped.

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 wasnt working. No script needed, no c/p, no deductible! Yayyy (585)227-8750 call if you need a supplier! Oh and we accept all BCBS

I love my free breast pump! We have BCBS and went through Edgepark but had to jump through a bunch of hoops–I think everyone is really confused by the new legislation. Hopefully at some point it won’t be so difficult!