After a fairly uneventful experience breastfeeding my first four children, my latest baby baffled me (as they often do) when it came to breastfeeding. she was born five weeks early, she refused to breastfeed. It was important to me personally to give her breast milk, so I made a commitment to join the world of exclusive pumping (ep).
after a few weeks of pumping 24 hours a day with my traditional double walled electric pump, one of many types of breast pumps available, while caring for my newborn, four other children who required to be carried back and forth to school every day and my husband worked outside the home, I knew I needed help. I decided to consider purchasing the Elvie, a hands-free, cordless pump that would allow me to pump while taking care of the rest of my parenting duties. the problem? the elvie was very expensive. so i went to my health insurance plan to see if i could get a breast pump through insurance; those experiencing the brunt of the formula shortage might be interested in the same thing, and here’s what I found out along the way.
can you get breast pumps through insurance?
Not only can you get a breast pump through your insurance, but legally, your health insurance plan has to cover it for free, with no copays. All health insurance plans, including Medicaid, must cover breast pumps by law. the only exceptions are some protected plans, which don’t have to offer the coverage, though many still do.
“Thanks to the Affordable Care Act (ACA), health insurance companies now provide coverage for a wide range of women’s health care services, including breast pumps and supplies, usually at no cost to you ”, explains natasha cantrell, director of individual and family sales for ehealth.
Are breast pumps free with insurance?
Some breast pumps will be 100% free through your health insurance plan. however, there might be rules about what type of breast pump your insurance allows you to get, such as manual or electric, or only certain brands. Also, some plans may only allow you to rent a pump, not keep it.
Other types of health insurance plans may allow you to purchase your own breast pump and then reimburse you up to an allotted amount. For example, my insurance plan would have covered a traditional pump in full, but since I wanted the elvie, I bought the pump myself, submitted the receipt to my insurance plan, and they sent me a check for the amount allotted, which ended up being half the cost I paid for the pump.
how to get a breast pump through insurance
While all of that probably sounds great, you’re probably wondering: how do you get a breast pump through insurance? there are some steps you can follow:
Step 1: Find out what your insurance covers.
Each insurance plan will be different in exactly what it will cover, so you’ll want to check the details of your plan. If you have an online account or application, see the benefits guide under “pregnancy” or “breastfeeding.” I was able to find my information very easily in the online benefits guide. If you can’t find it online, you can also just call your insurance benefits number.
Some insurance plans may also contact you if you tell them about your pregnancy. For example, after enrolling in her health plan’s “pregnancy wellness” program, Gretchen Bossio, a mother of five, received a phone call from a benefits coordinator when she was 32 weeks pregnant to request her pump. milk. after confirming that the pump she wanted was on the approved list, she was ready. “The bomb arrived in the mail a week later,” says bossio. “So easy! I was so grateful!”
If you have commercial insurance, you can also get a more expensive pump at a lower cost, explains Jason Canzano, CEO of Acelleron. “In these cases, you can ‘upgrade’ by using your insurance to help subsidize the cost of a more expensive pump, like a portable breast pump or a pump that comes with a bag and other extras,” he says. Basically, the price of the pump is reduced by the amount the insurance company pays the provider of the breast pump and you would be responsible for the difference.
Step 2: Follow the steps in your plan to order your pump.
again, each plan will be different, so it’s important to check with your specific plan about coverage rules. For example, some plans may require a doctor’s order or prior authorization, some may cover only certain brands or types of pumps, and others may require you to order a pump through a third-party site.
for example, erin heger, a mother of two, found edgepark, a third-party organization that partners with insurance companies, through google. she entered her insurance information, she chose a spectra 9 and that was it. “I was fully covered by insurance and the process was very easy,” she explains. “The pump was sent to me a few weeks later.”
canzano adds that finding an in-network durable medical equipment (dme) breast pump provider can help parents through the process of requesting a pump. for example, acelleron verifies insurance information and can even request a prescription from your doctor on your behalf, so you don’t have to call your insurance or your doctor. (if you already have a recipe, you’ll just upload it to the site).
Using an outside provider can also be helpful because you can order the pump at any time during your pregnancy once you have a prescription, although the company may not be able to physically ship the pump until approved by the insurance plan . For example, you can submit your information in your second trimester so you’re ready and off your to-do list, but if your insurance plan stipulates that you can’t have the pump until you deliver, the company must follow those rules.
Step 3: Be on the lookout for any specific rules.
Speaking of rules, sometimes getting your breast pump through insurance can be as simple as filling out an online form, but it’s also important to note that some insurance plans may have specific rules about pumps. milk. For example, Katie Waite, who has five children, was eligible for a new pump with each pregnancy, as long as they were 18 months apart, but found out the hard way that her insurance plan also had a cruel warning: she couldn’t apply for the pump. until after she gave birth.
“when I was pregnant with my first baby and I called my health insurance, the lady on the other end of the line told me I couldn’t order one until the baby was born, ‘just in case the baby didn’t make it’ , and well, that pretty much reduced me to a puddle on the floor that week,” says Waite. “Later I called and complained and they said that is not what they should have told me, but that it was the policy.”
Again, the rules for each insurance plan will vary, but Cantrell recommends contact your insurance company for details during your second or third trimester. In general, Canzano adds that most Most insurances cover one breast pump per pregnancy, but there are some insurance and Medicaid plans that only allow one pump for a certain number of years, and very rarely, only one pump for life.
what brands of breast pumps are covered by insurance?
Unfortunately, some brands of breast pumps may not be fully covered by insurance or not covered at all. so if you have a specific type of pump in mind, be sure to check with your insurance provider to see if it’s covered. Alternatively, it’s worth investigating if they offer a refund option that you can take advantage of, as I did.
“At the moment, the portable breast pumps made by Elvie and Willow are generating the most buzz even though they are rarely covered by insurance due to their high price,” Canzano says.
However, the good news is that there are many more affordable models of portable breast pumps on offer, so you may find a different option that works just as well for you. “medela and spectra breast pumps are probably the two most popular and well-known brands outside of the portable device category that make up the majority of the breast pump market,” he adds.
other frequently asked questions about breast pumps:
The most important step in getting a breast pump through your insurance is to check with your plan about its coverage rules, but there are other things it can be helpful to know as well.
how long do you have to get a pump after your baby is born?
Canzano notes that most plans generally allow you to request a pump up to 12 months after your baby is born. again though, this can vary so be sure to check.
what does medicaid cover for breast pumps?
While most Medicaid plans across the country cover a breast pump, Canzano adds that there are some state Medicaid plans that didn’t accept federal money and therefore don’t have to follow the service guidelines. of preventive health of the aca.
“These plans generally only cover a breast pump if there is a medical need, which means the baby is unable to breastfeed due to a medical condition such as prematurity or an oral defect,” she explains. again, she’ll have to check with her specific plan for the rules.
what if you don’t have insurance?
Canzano explains that if you don’t have health insurance, your options are:
- pay out of pocket for your pump.
- pay with an fsa or hsa card.
- check with your wic clinic to find out if you are eligible to rent or get a free pump and what other services may be available to you.
- It is not recommended that you share a breast pump that has been used by someone else; the only way to do it safely is through a licensed provider to make sure it has been properly cleaned and sterilized.