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Thread: Renting a Pump Under the Healthcare Reform Law

  1. #1

    Default Renting a Pump Under the Healthcare Reform Law

    Hi, I'm not sure where to post this. Has anyone in the US tried to get their insurance to pay for their breast pump rental under the new healthcare law? I'm renting a Medela Symphony, and my insurance tells me they only cover it if there is a specific medical need, and that tongue tie (which is our need) is not one of their "approved" needs. Honestly, I think having a baby is need enough, but I did get a prescription from my primary care physician, since they asked for one. They tell me that their policy is within the new healthcare law, but I don't see anywhere in the law where it says breast pump rental is covered only when deemed medically necessary by the insurer, even when the prescribing doctor already has deemed it necessary. Does anyone else have experience with this or advice about next steps? Thanks!

  2. #2
    Join Date
    Jun 2012
    Posts
    84

    Default Re: Renting a Pump Under the Healthcare Reform Law

    My health insurance paid for a good pump to return to work and school. I believe it would cover a rental only if there was a need / prescribed by our pcp, as you said. I'm not sure of any more specifics, sorry. I would think that it should be covered in a case like yours. Have you spoken with the hospital you rent from about it? And called your insurance again now that you have the prescription for it? Good luck!!

  3. #3

    Default Re: Renting a Pump Under the Healthcare Reform Law

    Hm, I'm not super knowledgeable about how it all works, but breastfeeding supplies/equipment rental is listed under the requirements for women's preventative services, which implies it should be covered as a matter of course.

    Health Resources and Services Administration-Supported Women's Preventive Services: Required Health Plan Coverage Guidelines

    Type of Preventive Service: Breastfeeding support, supplies, and counseling.
    HHS Guideline for Health Insurance Coverage: Comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum period, and costs for renting breastfeeding equipment.
    Frequency: In conjunction with each birth.
    BUT. Apparently, some health plans are exempt from the requirements, and the rest have to cover the services starting with the next plan year that begins after August 1, 2012.

    These guidelines are effective August 1, 2011. Accordingly, non-grandfathered plans and issuers are required to provide coverage without cost sharing consistent with these guidelines in the first plan year (in the individual market, policy year) that begins on or after August 1, 2012.
    I'm guessing that means most health plans won't cover pumps until January 2013.
    Karen
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  4. #4
    Join Date
    Feb 2012
    Location
    middle of IA
    Posts
    1,885

    Default Re: Renting a Pump Under the Healthcare Reform Law

    The new plan I'm on (a Blue Cross Blue Shield plan) just covers them as a matter of course, via reimbursement.
    DS1 6/7/11
    DS2 10/29/13

    Nursing, pumping, cloth-diapering, babywearing, working professor mama with the awesomest SAHD ever.

  5. #5

    Default Re: Renting a Pump Under the Healthcare Reform Law

    Thanks so much, Ladies! At first I was told my insurance wouldn't cover it because tongue tie was not an approved diagnosis, but then they called back and said I was approved after all, just for one month, after which time I have to get one of those special request letters from my pediatrician. So it appears to have worked out in my case. Karen, I totally agree that because it's "preventative" it should just be provided without making people jump through extra hoops. I've heard anecdotally from friends that their birth control pills are suddenly free without them having to do a thing. I wish that were the case for breast pumps. If I'm still renting in January, I'll be sure to make the "preventative" argument. I get my back up so quickly when dealing with insurance people. They always seem to start with the premise of "you can't do that, and here are all the reasons why not..." But I somehow seem to have temporarily convinced them, against their efforts to the contrary.

    Anyway, thanks again for the input.

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