Requesting a Breast Pump from Your Health Insurance Carrier

Requesting a Breast Pump from Your Health Insurance Carrier

Requesting a Breast Pump from Your Health Insurance Carrier

Breastfeeding can be a wonderful and beautiful experience for both mother and baby.

Sometimes, life can complicate the breastfeeding process—perhaps a baby has trouble latching (often the case with premature babies), or a mom needs to return to work before her little one is weaned. In this case, breast pumps can play a key role in achieving success in breastfeeding. While these valuable tools were costly to obtain in the past—often running more than $300 out of pocket—there is now another option. The recently passed Affordable Care Act (ACA) will now require health insurance carriers to provide breast pumps to pregnant and nursing mothers.

How do you go about asking your health insurance carrier for your benefits? It is important that you understand the provisions in your own private health insurance plan in order to gain maximum benefits. Here are some tips on how to approach your insurance provider.

  1. Understand your plan and the benefits of the ACA. Do your research.Before you call your insurer’s customer service department and ask about a breast pump, you will need to confirm your eligibility. Some policies are ineligible and therefore are exempt from coverage.
  2. Be prepared with a list of questions when calling your health insurance carrier.It is important to ask about the specifics of the coverage within your plan. This may help you set reasonable expectations of your benefits.
    • Am I required to have a prescription in order to get a pump?  Who do I get the prescription from, my OB/GYN or my Personal Care Physcian? What does it need to say?  Are specific codes required?
    • What type of pump would be covered under my plan?
    • Would it be a manual expression pump or an electric pump?
    • Where would I get the pumps? Would I purchase it and provide receipt for reimbursement?
    • Would I use a network vendor or Direct Medical Equipment (DME) supplier? Would it be delivered to my house?
    • Am I covered for out of network benefits?  If so, can I get a pump from an out of network DME?
    • When can I order my breast pump? Would it be before or after the birth of my child(ren)?
    • Are lactation consultant services and visits covered in my policy?
    • Are there any restrictions such as the number of visits allowed with the lactation consultant?
    • If I need a hospital grade pump, how would I get one?
    • Would my accessories be covered, such as a car charger, battery packs, milk storage bags, etc?
    • Could I choose to upgrade to an electric pump if I was allotted a manual pump? Is there a cost and how much?
    • If there is co-pay, can I pay it with my Health Savings Account/Flexible Spending Account?
    • What brands of pumps can I choose from?
  3. Document all conversationsIt’s important that you take notes during your conversations with your carrier, paying special attention to details like the name of the person you spoke with, date and time, and what method of communication-phone or email. Since the implementation of the ACA and its benefits are fairly new for the health industry, this will help you address any potential discrepancies.
  4. Be confidentThese are your rights and benefits entitled to you by the law. Don’t be afraid to ask questions!

9 Responses to “Requesting a Breast Pump from Your Health Insurance Carrier”

  1. Desiree Miller June 3, 2013 at 7:15 pm #

    I am trying to find a direct medical supplier that carries this brand of pump and takes United Health Care…any suggestions? I tried Edge Park but my child would have had to spend time in the NICU to order it. My problem isn’t with my baby it is with my body, and I am having a hard time finding a supplier that isn’t Edge Park.
    Thank you for any suggestions!

    • Hygeia June 5, 2013 at 11:45 pm #

      Hi Desiree,

      Someone from our customer service department will be contacting you really soon regarding this.

      Warm Regards,

  2. Jessica June 6, 2013 at 1:25 pm #

    Hi, I have a prescription from my OB for a pump but don’t know if Hygeia pumps are available in my area? Please help. I live in Bakersfield, CA and would travel if I don’t have to drive too far. Thanks

  3. Nancy June 13, 2013 at 7:46 pm #

    Hi I am having the same issue as Desiree. I have United Healthcare and I really want your pump. Please contact me. I am due in November. Thank you!!

    • Hygeia June 13, 2013 at 8:53 pm #

      Hi Nancy,

      Someone from our customer service department will be contacting you really soon regarding this.

      Warm Regards,

  4. Laura June 20, 2013 at 2:12 pm #

    Hello, I was able to try the EnJoye pump when I was nursing my first daughter and really preferred it to the pump I had. Now that I’m preparing for a second baby, I’d really love to get one! However, I can’t find a DME that would be covered through Regence BlueShield in WA. GAP would only cover 50% of the pump after my deductible is satisfied. Please help!

  5. Tiffany H. June 26, 2013 at 10:27 am #

    I have Geisinger Health Ins. (live in Pa). I just called ins. co. to be told that they only cover rental pumps. I was told once before by them that they only cover Medela rentals. I have my own Medela pump and it’s only 2 yrs old and I have issues with it. I’m also not loving using it anymore after I read info about open system pumps (which I wish I knew before I bought it 2 yrs ago). I long to own a Hygeia pump so bad but I really cannot afford to purchase my own right now. My son is 13 days old. Why can’t my insurance cover me to own my own pump (a Hygeia)? I really do not want to rent or continue using my Medela.

  6. Nikki June 28, 2013 at 7:32 am #

    Direct Healthcare Supply is in network with UHC and offers the Hygeia.

  7. Page June 28, 2013 at 1:26 pm #

    Hi there!

    I am covered under Regence, and there are 3 companies covered 100%, but I don’t believe any of them carry your pump. Is there a way to get them to do so? I would love to be a Hygeia Cheerleader!