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Old 03-15-2016, 03:03 PM   #1
sprior
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Exclamation How I got my hospital grade pump paid for by insurance

Hi ladies. Thought I'd share this information since it was a struggle for me. Since the affordable care act was passed, health insurance cos now pay for pumps, which is great.

However, my baby #3 was born last year and I already had a pump-in-style, purchased in 2008.

I MUCH prefer using the Medela Symphony (aka hospital grade pump) at work. Faster, gentler and more efficient. Did I say gentler? So much easier on the body. Makes such a difference. Oh yeah, and you pump MORE milk. And, it's TOTALLY quiet. It's amazing. Anyway, on to my process.

Since I didn't need a new single user pump, I rented the Symphony (5 months for $295 where I live) and was able to get it reimbursed by my insurance--which is United Choice Plus.

Thought I'd share the codes I used on my claims in case anyone else wants to try. By the way, my insurance co was adamant that they don't pay for rental pumps, and kept citing this BS research study that shows they are no more effective. I tried fighting and writing letters and explaining why the study they were citing was wrong (long story short there are none that have ever been properly done), and none of that worked.

what did work? got a code from my pediatrician, and other from the pump rental co, submitted a claim, called about 12 times to check on it... and I got paid.

Here are the codes I used:
Diagnosis Code: 779.31
Item code: E0604 (for the medela symphony)
Provider NPI (get this from the place you rent your pump from), if you happen to live in NYC you can use worldwide surgical supply in Brooklyn and their NPI is 1154307643... but that # will be specific to the place you rent from. They can tell you what it is when you rent your pump.

a final note: You can SHARE your rental pump easily with other pumping moms at work, which is another cost saver. They are designed to be shared. I'm sharing mine now and it works great, we just email when we're about to pump to make sure we don't overlap.

Cannot recommend a hospital grade pump enough, and I've pumped for 34 months now and counting.

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Old 03-15-2016, 03:58 PM   #2
mlrupton
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Re: How I got my hospital grade pump paid for by insurance

That's awesome! Thanks for sharing. Great info!
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Old 03-16-2016, 08:00 AM   #3
twood80
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Re: How I got my hospital grade pump paid for by insurance

Note that because you did this a while ago, that's an ICD9 diagnosis code. We're now in the ICD10 world (post October 1, 2015), so any current claim would need to be with an ICD10 diagnosis code.
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Old 03-16-2016, 11:03 AM   #4
Futurefam
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Re: How I got my hospital grade pump paid for by insurance

Quote:
Originally Posted by twood80 View Post
Note that because you did this a while ago, that's an ICD9 diagnosis code. We're now in the ICD10 world (post October 1, 2015), so any current claim would need to be with an ICD10 diagnosis code.
True!

You can convert ICD-9 to 10 with this site below or ask a professional provider for assistance.

http://www.icd10data.com/Convert/779.31


"Convert ICD-9-CM 779.31 to ICD-10-CM



ICD-9-CM 779.31 converts approximately to:
•2016 ICD-10-CM P92.1 Regurgitation and rumination of newborn
or:

•2016 ICD-10-CM P92.2 Slow feeding of newborn
or:

•2016 ICD-10-CM P92.8 Other feeding problems of newborn
or:

•2016 ICD-10-CM P92.9 Feeding problem of newborn, unspecified

Note: approximate conversions between ICD-9-CM codes and ICD-10-CM codes may require clinical interpretation in order to determine the most appropriate conversion code(s) for your specific coding situation.

Source: 2016 ICD-10-CM CMS General Equivalence Mappings."
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Last edited by Futurefam; 03-16-2016 at 11:04 AM.
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Old 03-16-2016, 02:28 PM   #5
sprior
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Re: How I got my hospital grade pump paid for by insurance

thanks for updating with new diagnosis codes... I didn't realize they change every year, but maybe I should have since it took 6 months to get paid for my claim! I hope some other moms have success with this.
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Old 03-16-2016, 02:37 PM   #6
Futurefam
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Re: How I got my hospital grade pump paid for by insurance

Quote:
Originally Posted by sprior View Post
thanks for updating with new diagnosis codes... I didn't realize they change every year, but maybe I should have since it took 6 months to get paid for my claim! I hope some other moms have success with this.
Actually the codes only change about once a decade so you should be good for a while.
Sorry for crashing this thread as I would never have a reason to have my insurance pay for a pump since I'm not that kind of mom yet (lol) , something just caught my eye!
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