Breast pumps are covered by insurance with no copays! (If you’re willing to do some work.)

by Karen on July 15, 2013

When I was pregnant with Judah, I planned to be a 100% stay-at-home mom, so I didn’t invest in an expensive breast pump. It turned out I didn’t need one. I only pumped a handful of times, so a $300 pump would have been overkill.

However, for full-time working moms who want to breastfeed, an expensive double-electric pump is essential if you’re going to have any chance at successfully breastfeeding. That’s why the Affordable Care Act included provisions that require health insurance companies to cover breast pumps and other necessary breastfeeding supplies (and lactation consultant services!) at no cost to the insured (read: no copay). Woo hoo, right?

Well, not so fast.

I will be home full-time for the first 4 months with this baby. After that, I’ll go back to a part-time teaching schedule. As of right now, my schedule will have me on campus two hours a day, three days a week. We’re fortunate that my husband’s teaching schedule is flexible, so he’s able to stay home with the kids while I’m on campus teaching. I didn’t start teaching until after Judah stopped breastfeeding, but this time, I’d like to make sure there are bottles on hand in case baby is hungry when I’m gone. Hopefully, as long as I nurse before I go, the baby won’t need to nurse again until I’m home. But you never know! Since I’ll be away from this baby more than I was Judah, I decided to redeem my 100% covered breast pump.

Unfortunately, it’s not as simple as it sounds.

Breast pumps are sold at most big box retailers. Depending on the model and features, double-electric pumps range from $150-$400. Like all products, some are more efficient and easier to use than others. Some come with fancy features to make things more convenient for moms.

When I heard about the ACA provision, I assumed I’d be able to purchase a pump in a retail store and submit my claim for reimbursement. Wouldn’t that be so simple? That’s not how it works. At all.

First, you have to obtain a prescription for a breast pump from your OB or midwife. My midwife wrote the prescription at my last appointment, and she told me that she’d written it specifically for a double-electric pump. Apparently, if the prescription doesn’t specify “double-electric pump,” insurance companies can insist on only covering inefficient manual pumps, which are not sufficient for moms who will be pumping daily.

Once you have your prescription, you need to contact your insurance company to find an in-network durable medical equipment supplier. But here’s the catch: when I searched for a list of in-network DME suppliers in my area, I found a very short list. I called every one of them. Not a single one offered breast pumps. So I was confused.

I absolutely despise calling my insurance company (I’m always on hold forever, and they are rarely helpful). So my first call was to a lactation consultant at the hospital where I plan to deliver. My hospital is working toward baby-friendly certification, and they have an awesome lactation center that rents and sells breast pumps. I wondered if I’d be able to purchase a pump from them and be reimbursed, since they’re an in-network hospital. Unfortunately, according to the lactation consultant, they will not bill my insurance company directly, but she said I might be able to purchase it there and submit a claim for reimbursement. I’d need to call my insurance company to be sure.

After three different calls, I was given three different answers: maybe, if they’re in-network; yes, because they’re in-network; and finally, no, it would not be reimbursed because even though they’re in-network, they’re not an official DME supplier.

Since there are no DME suppliers in my area who offer breast pumps, the insurance company gave me a list of mail order DMEs that are in-network. I will need to fax or mail them my prescription and insurance information, and they will ship me a pump.

Here comes the second catch: their selection is very limited, almost always out of stock and on back-order (so order early if you can!), and their options are the bare bones models. I will be able to get a double-electric pump that will be sufficient for my needs, but it won’t include any of the extras I would get with a retail pump. I suppose I’m not surprised that’s the case, but I’m disappointed that breastfeeding moms who want to take advantage of this will be so limited in their options.

The earliest my insurance company will allow me to order the pump is 30 days before my due date. Some insurance companies won’t fulfill breast pump prescriptions until after the baby is born, so check with your in-network DME early to see if you can get a head start on the paperwork and order the pump as soon as your insurance company allows. Cross your fingers that there will be pumps in stock, and you won’t have a 6-8 week wait like I will.

I was incredibly frustrated, but I’m sharing my experience to let other moms know that it can be done. If you have a specific pump in mind, and the extra money to spend on it, you might want to go ahead and make the purchase on your own. Unfortunately, I suspect that’s part of why insurance companies have made the process so complicated — they hope women will just purchase a pump out-of-pocket so they can get the exact model they want before the baby arrives without all the hassle. If funds are limited, or you’re insisting that your insurance company honor the requirement on principle (I pay a lot of money in insurance premiums! If the law says they have to cover my breast pump, they’re going to cover it, dang it!), be prepared to do some research, be aware of your rights, and get the ball rolling early.

Have any of you received a breast pump from your insurance company? What was the process like for you?

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{ 3 comments }

1 Kacie July 15, 2013 at 12:47 pm

What a giant pain! I really hope it isn’t always this complicated.
Kacie´s last blog post ..Update from Courtney: Part 10 DEBT-FREE!

2 Jane August 1, 2013 at 12:56 pm

I didn’t receive a breast pump from insurance, but I definitely needed one. My kid wasn’t so great at nursing, so after he started completely refusing any attempt to latch him around 5.5 months, I exclusively pumped until about two weeks after his first birthday. In fact, I ended up getting a second pump (from craigslist, replaced the tubing and got all new accessories) to keep at the office. I pumped at a friend’s office at the Mexican Consulate after a meeting there; in the bathroom at the Illinois Holocaust Museum; several times on the plane; and a couple of times in a moving car while visiting my mom in Las Vegas.

3 Amy September 5, 2013 at 6:51 pm

:( So sorry you had such a rough experience!! Thanks for the post though, I had no idea until I read it! I have BCBS of MA, but live in TN. Anyway, they told me exactly what to have the prescription say (didn’t care if it was from an OB, midwife, Ped., regular Dr), they called suppliers for me until they found one that not only was in network but also carried the Medela brand/model they cover then gave me their name and number, and then gave me the billing code to be sure it gets covered. The supplier told me I’d wait 2 weeks at the most when I order for it to arrive to me. So I guess it just depends on the insurance company! I’m NOT a fan of insurance companies, but this one has been the best I have ever dealt with. I’m about 17 +some days weeks pregnant (I’ve followed your blog since before you had Judah, but I never comment!) and with my Daughter I only had a manual pump and therefore, I didn’t pump and she wouldn’t take a bottle at all – kind of a pain when you do have to go do something. Now I’m getting a dual electric pump and pumping not only for new baby, but for my best friends who are adopting a baby as well….pretty “pumped” about that :)

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