If you’re an expecting or new mother, the costs associated with your child — such as a breast pump — can quickly add up. Fortunately, many insurance plans are required to cover breastfeeding equipment and supplies under the Affordable Care Act.
In this blog post, we’ll discuss some important facts about how to get breast pump through insurance coverage and steps and tips to expedite the process.
Key Takeaways
How to get breast pump through Insurance
It is crucial to know what type of free breast pump your health insurance covers, any coverage limits or restrictions, and eligibility requirements.
Types Of Breast Pump Covered
Regarding breastfeeding, health insurance usually offers coverage for breast pump. Many policies cover several types of systems from which mothers can choose the one that best suits their needs.
Generally, basic manual breast pumps are free and offered with no upfront cost or co-pay, while double electric pumps and other higher-end devices may require some form of additional payment.
Coverage varies by policy, so check with your provider.
Manual Breast Pumps involve using a hand pump connected to suction cups that fit over the breasts and similarly stimulate breast milk into production as nursing an infant would do; this is usually provided at no extra charge under most health insurance plans.
Automatic Electric Breast Pump models are also available from many suppliers covered by insurance plans. However, getting all parts approved may be difficult depending on what specific system you select; for breast pump options this might include motors, tubing replacements, etc.
Some companies offer Maintenance plans for these more advanced products, which entitle users to receive almost immediate response times when requesting replacements or repairs under warranty conditions.
Coverage Limits And Restrictions
Most health insurance providers will cover breast pumps and certain supplies, with some limits in place. Generally speaking, typical coverage includes manual or electric breast pumps.
Insurance plans may cover both single-sided electric and dual-sided electric breast pumps, but coverage of specific types varies by state and type of plan.
Common restrictions include a limit to one pump per lifetime (or two for twins) and milk storage bags/containers being limited based low milk supply or on medical prescriptions from your doctor.
For example, under the Blue Cross Blue Shield of Michigan maternity benefits program, all manual or electric double-sided models are covered at no cost up to $741.20 every 59 months (i.e., 5 years).
Any additional items, such as tubing kits for pumping tips, must be purchased separately. In most cases, reimbursement is allowed via DME claims processing only if approved by your provider before purchase, depending on eligibility requirements, etc.
Eligibility Requirements
New and expectant mothers need to understand the eligibility requirements for obtaining a breast pump through health insurance, as coverage may extend up to one year postpartum.
Know that, under the Affordable Care Act, insurance plans are mandated to cover the costs of breast pumps durable medical equipment and supplies at no cost.
To qualify for free coverage, most basic information, such as current enrollment with an eligible health plan, several forms of paperwork or documentation may be required in addition to standardized procedure recommendations by healthcare providers.
The types of pumps covered typically include manual or standard electric pumps (non-hospital grade).
Steps To Quickly Get A Breast Pump Through Health Insurance
To get a breast pump through insurance quickly, you must check your coverage and ensure it qualifies. If so, your doctor must prescribe a breast pump with a cause.
How to Get Breast Pump Through Insurance Check List:
- Check insurance coverage for breast pumps and related costs.
- Obtain a prescription and discuss necessities with your doctor.
- Choose an in-network provider for the breast pump.
- Submit required paperwork, including personal info, pump type, and prescription.
- Follow up with your insurance provider to ensure timely processing.
1.) Check Your Insurance Coverage
New and expectant mothers must check their health insurance coverage before getting a breast pump.
Health insurance companies may pay the cost of a breast pump for pregnant or newly delivered members.
These plans typically require you to obtain a prescription from your doctor and choose an in-network provider to receive the free benefits.
Obtaining a breast pump through your insurance company can save money and time.
You may only have to pay co-pays or other minor fees to get the prescription from your doctor instead of the whole amount, which might be several hundred dollars depending on pump type and brand.
2.) Get A Prescription From Your Doctor
It might be necessary to get a prescription from your doctor to get a breast pump through insurance. The prescription is important in helping to verify the medical necessity for the breast pump and confirming that it meets your health plan’s requirements for coverage.
With this verification of information, you can avoid having your insurer deny or reduce coverage for the item, which could force you to pay out-of-pocket.
Your doctor or nurse can provide additional guidance on whether they think a breast pump would be beneficial given your circumstances and advise on any special features or accessories that are popular with their other patients who’ve received one.
Additionally, talk to them about any potential restrictions imposed by your particular insurance provider regarding where you purchase the device (e.g., an in-network vendor) as well as whether there should be any fees associated with obtaining necessary paperwork from their office based on what must be included on said documents (Note: some insurers require detailed information such as measurements ranging from chest size over bust diameter).
3.) Choose An In-network Provider
Choosing an in-network provider can benefit those seeking a breast pump through health insurance. In-network providers bill your insurance company directly and charge you nothing or a tiny co-pay.
Contract providers often offer competitive rates, lowering the expense of a breast pump.
In addition, choosing an in-network provider allows individuals easier access to supplies and products recommended or required by their insurance plan.
For example, some plans require all new mothers to buy specific brands of breast pumps unavailable at most retail outlets; however, these items may be more readily available through approved retailers within your insurer’s network, like Walmart and Target.
4.) Submit Necessary Paperwork
Submitting the correct paperwork is critical for new mothers, expectant mothers, and new parents to quickly get a breast pump through health insurance. This usually involves filling out an a breast pump order form from your insurance provider that includes your name, address, date of birth, type of breast pump you want to purchase or rent, and doctor’s prescription (if needed).
You should also provide any other relevant documents that could help verify your eligibility for coverage.
Depending on your insurance provider, submitting a copy of the baby’s birth certificate or proof of pregnancy might be necessary if you need quick access to a free breast pump.
It is always best to thoroughly read and understand all the submitted forms to ensure everything is correct and avoid delays or denials in processing time.
| Eligibility Requirement | Understanding Your Health Insurance Coverage for Breast Pumps |
|---|---|
| Insurance Plan | Check if your insurance plan covers breast pumps as part of the essential health benefits. |
| Coverage Type | Determine if your plan offers full or partial coverage, or if there are any out-of-pocket costs. |
| Prescription | Obtain a prescription from a healthcare provider to ensure proper coverage for a breast pump. |
| In-network Suppliers | Verify which suppliers are in-network to avoid additional expenses and maximize coverage. |
| Pump Type | Understand which type of breast pump is covered (manual, single electric, double electric). |
| Brand and Model Restrictions | Review any specific brand or model restrictions within your insurance plan. |
| Rental or Purchase Coverage | Check if your plan covers the purchase of a new pump or the rental of a hospital-grade pump. |
| Timeframe for Coverage | Learn when coverage begins (e.g., during pregnancy, after birth) and if there are any deadlines. |
| Replacement Parts and Accessories Coverage | Verify if your insurance plan covers replacement parts and accessories (e.g., tubing, flanges). |
| Preauthorization Requirements | Determine if you need preauthorization from your insurance company before obtaining a pump. |
Tips To Expedite The Process
Follow up with your insurance carrier, use online resources, and have all the required information to expedite breast pump coverage with insurance.
Expedite Breast Pump Coverage Process
- Follow up with insurance company regularly.
- Use online resources for easy ordering.
- Prepare and organize necessary information.
1.) Follow Up With Your Insurance Company
When trying to get a breast pump through health insurance, follow up with your insurance company. Most plans cover breast pumps and supplies.
Following up ensures that you have all the necessary information to expedite the process and avoid unnecessary delays.
Also, regardless if you’ve chosen an in-network provider or submitted all necessary paperwork prior, having regular contact with your insurer can help make sure everything has been noticed. Hence, everything runs smoothly during the delivery of your policy benefits.
2.) Use Online Resources
Online resources make getting a breast pump through health insurance fast.
Acelleron is an example of a company that makes getting a free breast pump easy by helping customers order their pumps without the hassle.
3.) Be Prepared With the Necessary Information
Before attempting to get a breast pump through health insurance, new mothers, expectant mothers, and new parents must have all the necessary information organized for a successful application.
This includes your health insurance information, such as your policy number and provider contact info, details about any out-of-pocket costs associated with obtaining the breast pump, and the brand name or model number of the specific breast pump you’d like to purchase.
If your policy requires a doctor’s prescription, check ahead of time.
Also, choosing an in-network provider will help ensure a smooth approval process, so research which providers offer quality products and reputable customer service.
Getting a breast pump through your health insurance plan can be confusing and time-consuming for busy and sleep-deprived mothers. However, taking advantage of your plan’s coverage for this essential tool is important as it is an instrumental part of helping with breastfeeding.
Michaelle Barbor
