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Old 03-08-2011, 11:58 AM   #1
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Rx for breast pump?

I have just recently read about this... that you can have your OB/MW write a prescription for a breast pump and depending on your insurance, it might be covered. Has anyone had experience with this? Is it for renting one from the hospital, or buying one? I am assuming that the first thing to do is to call insurance to see if they cover it and what percentage...
I had a breast reduction done years ago and have always had a hard time establishing supply. I had a Medela PIS, but gave it to a good friend who lives 300 miles away (we thought we were done ) and she still pumps and works full time, so I hate to ask for it back now. So, I was considering renting one from the hospital, but if it could be covered, that would be awsome!!!!
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Old 03-08-2011, 12:12 PM   #2
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Re: Rx for breast pump?

You just need to check with your insurance. Some do and some don't. But, yes if they cover it, you just get a Rx and you're good to go.
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Old 03-08-2011, 12:24 PM   #3
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Re: Rx for breast pump?

Also, if you have a health savings account, you can use money from it if you have a prescription. That is a recent allowance by the IRS.
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Old 03-08-2011, 12:36 PM   #4
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Re: Rx for breast pump?

Definitely check your insurance first...I called mine (Anthem BC/BS) and the lady on the other end about laughed her head off when I asked if they covered the cost of rental or purchase of a breast pump. I had a breast surgery also and was hoping to rent a hospital grade pump in hopes of increasing my supply.
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Old 03-08-2011, 01:13 PM   #5
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Re: Rx for breast pump?

Check with your insurance first, and then talk to your OB. My insurance covers them with a doctor's note and/or if my baby was in the NICU (where we were separated for some time). One specific pump (rented or sold through the hospital) was the only one covered, too. I casually asked my OB about it, and she told me that they are watched extra closely for that kind of thing (fraud), and most doctors won't prescribe one unless it is clearly medically necessary.
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Old 03-08-2011, 01:38 PM   #6
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Re: Rx for breast pump?

I called my insurance and they cover 80%... but there is a bulletin list of criteria that you have to meet, I haven't been able to open the email yet (have to figure out how to set up my password ). That would be really nice if we could use it!!
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Old 03-08-2011, 01:41 PM   #7
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Re: Rx for breast pump?

Insurance covered rental of the breast pump from the hospital from the time DD was born until she was about 13-14 weeks old. They covered it because she was IUGR and born with a heart defect. She went into heart failure, had a feeding tube, had surgery, then had the feeding tube again after surgery for a couple of weeks. They covered it until the feeding tube was removed for the last time. My insurance at the time was United Healthcare and Tricare.

You'll have the best chance of getting it covered if you can show that breast milk is medically necessary for the baby and you need the pump in order to provide milk. That was the criteria that our insurance specified, anyway.
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Old 03-08-2011, 01:48 PM   #8
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Re: Rx for breast pump?

I was finally able to view the email and it stated they will cover it:

1. For the period of time that a newborn is detained in the hospital after the mother is discharged; breast pump rental is not considered medically necessary once the newborn is discharged; or

2. For babies who have congenital disorders that interfere with feeding, a breast pump is considered medically necessary for up to 12 months of age.

And hopefully neither of these will apply to us. Darn, oh well... worth checking into!
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Old 03-08-2011, 01:47 PM   #9
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Re: Rx for breast pump?

I had one covered at 80% by insurance compnay because LO was in the NICU. Call your insurance company, some may cover anyway.
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Old 03-08-2011, 07:58 PM   #10
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Re: Rx for breast pump?

My primary won't but my secondary will, Rx or no (I can just submit a receipt). BCBS of Oregon pays at 90% at a participating DME supplier or 80% at a retail store (think Babies R Us). I have to get an Rx anyways though to get it through my primary insurance-they will just pend it for a Rx and I need them to deny so I can send it to my secondary. Even employer groups are different, when they build your plan your employer may have the choice to allow (or not) breast pumps. My husband's pharmacy carries the BCBS and they have an allowance for homebirths, Intel employees have a nearly identical plan, but they don't allow homebirths. Employer choice
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