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Old 01-16-2013, 01:54 PM   #1
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Breast pump insurance help

I contacted my insurance about coverage for a breastpump but was told that only covers nicu babies while they are in the nicu. Anyone navigated this under the affordable care act?

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Old 01-16-2013, 02:02 PM   #2
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Re: Breast pump insurance help

You don't happen to have tricare do you? Apparently tricare is exempt, maybe your insurance is too?
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Old 01-16-2013, 02:58 PM   #3
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Re: Breast pump insurance help

I know the plan I have under Humana was "grandfathered" in, so is exempt from the new ACA, which is a complete bummer. Maybe that is something that is specific to your insurance plan? We've had a nice, lengthy discussion on our FB DDC page about this. If you post your questions HERE, you might get some good answers from those who have btdt.
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Old 01-16-2013, 03:24 PM   #4
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Re: Breast pump insurance help

I have BCBS through my husbands employer, and they said they would pay 100% if using a pump is medically necessary. So, if my doctor writes a prescription for a pump, they will pay. I've seen online where women have gotten scripts written for plugged or blocked milk ducts. In my case, I have implants that were put in through the nipple, so some of my ducts were severed and won't carry milk to my nipple, so my doc said he would write the script. My doc is a bit of a stickler and I feel he wouldn't write it unless I had a good reason, but it seems some doctors will write one upon request.

Your insurance company's reply makes me think they were grandfathered in because the literature I've seen wasnt that narrow.
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Old 01-19-2013, 07:31 PM   #5
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Also it depends on when your plan year starts. The ACA coverage starts with plan years that began in August. Unfortunately mine began in July so a pump wouldnt be covered until the next plan year startwd
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Old 01-19-2013, 07:36 PM   #6
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That is the case for my plan as well. Many existing plans were grandfathered in especially if you already have coverage.
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Old 01-19-2013, 07:46 PM   #7
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I don't know about them "being exempt". It is most likely your policy has not renewed since act passes.

I work for a Healy insurance company and know that birth control aspect does not go into effect for policies that tensed prior to August1st.

We have a benefit called "oh baby" that gives a free breast pump (we have had this benefit but before the act passed you had to choose a breast pump OR a car seat. Now you get both). Since you get a breast pump I am pretty sure that means we don't have to cover a better pump which still makes me sad
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Old 01-23-2013, 07:52 PM   #8
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My insurance told me they would cover a manual pump, not electric. So I think the insurance companies can get around it that way. And it was for the new year, so not a previous coverage they had.
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Old 01-24-2013, 01:38 PM   #9
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Re: Breast pump insurance help

I did some research on this last night for a blog post I wrote last night. From what I gather, every insurance is going to handle things differently. Some will only cover rentals. Some will cover a purchase. Some will cover electric, some only manual. All will require a prescription and purchase through a "medical dealer."

We have UHC and are grandfathered in. I was told to call back July 1 and see what coverages will change.

Very frustrating to say the least.
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Old 01-25-2013, 05:26 PM   #10
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Re: Breast pump insurance help

I just called mine Tuesday. They will cover a pump but it has to be thru a dealer and they won't cover it with a perscription can't be hospital grade they told me to use edgepark who are out and not even taking orders and have a shortage. But I'm not due til may so no big deal for me. I have BCBS North Carolina
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