Getting Insurance to Pay for Your Breast Pump

Under the Affordable Healthcare Act, all healthcare plans that begin after August 1, 2012, are required to provide 100% coverage on breast pump purchases or rentals. That said, your insurance company might have restrictions on which brands they cover and the types of pumps they will provide coverage for, ranging from manual to electric double-breast pumps.

My breast pump claim was denied after numerous phone calls, a lot of research, and weeks of wasted time. For whatever it’s worth, I did learn some things from the experience — and not just about misogyny in women’s health care coverage.

If I had to do it over, I would err on the side of caution and assume before giving birth that I would have trouble breastfeeding. Eight months into my pregnancy, I thought breastfeeding would be a breeze and I would only need a breast pump if I decided to work outside my home. I was wrong, and dealing with a difficult health insurance company is just about the last thing you’ll want to do when you’re recovering postpartum and trying to get the hang of keeping a tiny person alive.

Call your insurance company well before giving birth and find out exactly what types of breast pumps your plan covers. Have them provide you with breast pump coverage information in writing because, if your insurance company is anything like mine, you will get different answers to your questions, depending on which call center employee answers your call. You should also provide your pediatrician, lactation consultant, and medical supply company with the breast pump coverage documentation so that they can help you get the best coverage for your breast pump.

If your insurance plan is grandfathered, meaning it existed on or before March 23, 2010, and doesn’t have to comply with the Affordable Care Act’s provisions for new mothers, you’re unlikely get full coverage for a breast pump. Some insurance plans still only cover pumps if they deem a pump medically necessary in your particular situation. In this case, it’s essential for you to find out what constitutes medical necessity and ask your doctor or your infant’s pediatrician if you or your baby qualify. My insurance company, for instance, required a letter of medical necessity from my doctor as well as a prescription for a breast pump. After reviewing my doctor’s letter, they decided that my doctor’s definition of medical necessity was different from their own, so I was out of luck.

Lastly, find out which medical supply companies your insurance plan will work with. Most insurance plans will provide you with a list of in-network suppliers. Naturally, when I asked my insurance plan for a list, they told me they did not provide in-network breast pump supplier information and that they had never heard of any member finding an in-network breast pump supplier. I did some online research and eventually found an in-network medical equipment supplier that sold breast pumps. Had my breast pump been considered medically necessary, it would have been covered at 90% using the in-network supplier I found, as opposed to 50% coverage using an out-of-network supplier. So, it’s worth going in-network if you can.

The bottom line is this: it’s up to you to find out if your insurance company is going to make you jump through multiple hoops in an attempt to deny you breast pump coverage. If your insurance company is grandfathered, take a deep breath and get ready to jump through those hoops with an infant and a sore vagina.

But don’t let my less-than-ideal breast pump coverage experience scare you. Thanks to the Affordable Care Act’s provisions, most of the moms I talked to had positive experiences getting their breast pump covered by their insurance plan and dealing with their medical supply company. In fact, breast pump supplier Yummy Mummy came up time and time again and was touted as a pleasure to work with. Most people said they just filled out one form and received their fully covered pump in a couple of days.

Good luck!