Wednesday, February 27, 2013

Breast Pump Insurance Coverage & Reimbursement

   As the Affordable Care Act is enacted and more and more moms are becoming aware of the benefits of it, we are learning more and more about getting insurance to cover your breast pump.
 First, don't take "no" for an answer.  Call your insurance company.  If the representative tells you that a breast pump is not covered ask why.  Some insurance companies are still classifying breast pumps as "personal comfort" items.  According to the US Government Department of Health & Human Services, " 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."
     The Affordable Care Act covers Breastfeeding support, supplies, and counseling.  Some insurance companies are covering hospital grade breast pump rentals, but others are covering quality personal use pumps sold by DME supplies like Lactation Connection.  We found the United Health Care policies buried in a table entitled Expanded Women's Preventative Health and it states that these items are required coverage for plans beginning after 8/1/12.
     Make sure to get prior approval from your insurance company before purchasing from an out of network supplier, especially if you are on an HMO.  But it is always a good idea to call your insurance company first for information on how to get reimbursement.  Take down the name of the person you spoke to.   If the answer is "we don't cover that"  ask why and if the answer is not that you have to buy "in network" or that your plan is grandfathered.  Call back and speak to someone else until you get a knowledgeable helpful representative.  Finally, ask what paperwork you need to submit for reimbursement.  Lactation Connection provides you a receipt with the appropriate insurance codes attached for your convenience when you purchase at http://www.lactationconnection.com


http://www.hrsa.gov/womensguidelines/
http://www.healthcare.gov/news/factsheets/2010/07/preventive-services-list.html#CoveredPreventiveServicesforWomenIncludingPregnantWomen
https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/Preventive_Care_Services_CD.pdf

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