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Thread: Insurance covering Breast Pumps!

  1. #1
    Join Date
    Dec 2009
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    177

    Default Insurance covering Breast Pumps!

    So I had read this a couple of times online and thought there would be some loophole with my insurance and they wouldn't cover it. But I called today and they are covering the pump 100%! With my insurance (Anthem Blue Cross VA) they require you to buy from an in-network medical supply company and that company will directly bill the insurance. Thanks to the Medela website for the list of suppliers, I was able to find a participating medical supplier. I called the supplier and he required a "prescription" from the doctor (no big deal).

    This is all due to the 2012 Health Care reform bill which went into affect August 1st.

    So it is possible!
    Trying to keep up with a busy 3.5 year old Morgan Alexis born 11/5/09 at 6 lbs 5 oz and proud retired 1 year EP'er!

    Nursing our new addition Jordan Catherine born 10/21/12 at 7 lbs 14 oz.

    Total donated milk so far - 1,368 ounces!

  2. #2
    Join Date
    Jun 2009
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    6,564

    Default Re: Insurance covering Breast Pumps!

    That's awesome!
    Tracie

    Mommy to
    Lilah 10/08 nursed 25 months
    Beatrix 01/11 nursed 30 months

  3. #3
    Join Date
    Jan 2012
    Location
    Northern Virginia
    Posts
    539

    Default Re: Insurance covering Breast Pumps!

    I'm curious -- did you have to get around the "medically necessary" thing? I felt it wasn't worth the hassle, but I read the definition of "medical necessity" in my benefits brochure and it's very vague. What would be a medically necessary reason to breastfeed -- as if formula is the norm and breastfeeding would be the alternative??
    Mom to my sweet little "Pooper," born 10/12/11, and "Baby Brother," born 6/23/2014, and married to heavy metal husband. Working more than full-time, making healthy vegetarian meals for family, and trying to keep up with exercise routine.

  4. #4
    Join Date
    Mar 2008
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    2,538

    Default Re: Insurance covering Breast Pumps!

    Quote Originally Posted by @llli*filmmommy View Post
    I'm curious -- did you have to get around the "medically necessary" thing? I felt it wasn't worth the hassle, but I read the definition of "medical necessity" in my benefits brochure and it's very vague. What would be a medically necessary reason to breastfeed -- as if formula is the norm and breastfeeding would be the alternative??
    WORK, having to leave the home and go to work makes pumping medically necessary.... Formula is inferior it is a replacement for Breastmilk.....

    you do NOT have to prove that breastfeeding is medically necessary... just that pumping is necessary


    additionally if you return to work (while already BF) and do not pump there are a host of medical issues which would affect you , pumping avoids those
    Autumn
    Moma to *Silas* 10-30-07

  5. #5
    Join Date
    Dec 2009
    Posts
    177

    Default Re: Insurance covering Breast Pumps!

    Here's how my insurance company worded things.

    http://www.anthem.com/provider/noapp...vider&state=me

    I don't think the reform bill mentioned "medically neccessary" at all and that may be something the insurance company is adding? I'd make sure you reference the August Reform Bill when asking the insurance company.
    Trying to keep up with a busy 3.5 year old Morgan Alexis born 11/5/09 at 6 lbs 5 oz and proud retired 1 year EP'er!

    Nursing our new addition Jordan Catherine born 10/21/12 at 7 lbs 14 oz.

    Total donated milk so far - 1,368 ounces!

  6. #6

    Default Re: Insurance covering Breast Pumps!

    It's included under women's preventative services, and insurance plans are required to cover

    Comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum period, and costs for renting breastfeeding equipment.
    So nothing about medical necessity. But it also says

    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 don't know about other insurance companies, but my family's insurance plan year begins in January, so I don't think this requirement would kick in until January 2013.
    Karen
    Forums Admin

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  7. #7
    Join Date
    Apr 2011
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    1,293

    Default Re: Insurance covering Breast Pumps!

    thats great! i read through that link but could not tell if LC are covered.

    how do we all find out about our own insurance? just call?

  8. #8

    Default Re: Insurance covering Breast Pumps!

    You might be able to find your plan benefits online. I just checked ours and for 2012 pumps aren't covered. Breastfeeding counseling is, but only from lactation consultants who are RNs, which rules out many IBCLCs.
    Karen
    Forums Admin

    Find an LLL Leader or Meeting | Get one-on-one help from a Leader online | Become a Member of LLLI

    Feel like you need professional help? ¿Es usted necesita ayuda profesional? --> Find an International Board Certified Lactation Consultant (IBCLC) <--

  9. #9
    Join Date
    Apr 2011
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    Default Re: Insurance covering Breast Pumps!

    Quote Originally Posted by @llli*LLLKaren View Post
    You might be able to find your plan benefits online. I just checked ours and for 2012 pumps aren't covered. Breastfeeding counseling is, but only from lactation consultants who are RNs, which rules out many IBCLCs.
    i'll look mine up. i dont get why they rule out IBCLC

  10. #10
    Join Date
    Mar 2008
    Posts
    2,538

    Default Re: Insurance covering Breast Pumps!

    Quote Originally Posted by @llli*mtmama View Post
    i'll look mine up. i dont get why they rule out IBCLC
    because they want to deal with big corporations not individuals.... they would much rather deal with a Central Billing Office and get a 'bulk' discount or think of it as a per head price when negotiating.... when an insurance company is hashing out terms with a provider/hospital (or CBO) they often use their member numbers as a bargaining chip to reduce costs.... especially if it's a standard PPO or HMO plan that way they reduce their own costs.... so a Insurer would say I've got 100,000 covered lives in plan A and if you agree to only charge 50.00 per consult then I will exclude IBCLC consults from plan coverage.... big corporate giants helping big corporate giants....or why I hate my job

    also PLEASE understand that the 2012 Health Care reform bill was awesome but it also included several tiny loopholes that insurers will continue to leverage until about 2014... big corporations like my employer have been employing individuals to do nothing but find tiny loopholes that buy them a few months/years and meanwhile pouring money into lobbying to have pieces and parts of the reform bill revoked....


    as for how your plan addresses breast pumps and LC visits. please look into your specific plan's coverage....
    Last edited by @llli*lidarln; September 24th, 2012 at 12:24 PM.
    Autumn
    Moma to *Silas* 10-30-07

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