ObamaCare and breast pumps???

[Ellasundies]

Hi everyone,

I'm trying to fight with my ins. company to get them to pay for a new pump for me. Aetna used to only cover breast pumps if baby or Mom were separated or if baby had some kind of a problem that prohibited baby from nursing. However I've since heard that they now have to pay for breast pumps.

Baby is 9 months and my pump just died. Dh called our ins. company and the person he got definitely did not seem to know what they were talking about and was saying stuff about how they will only pay for 50% of the pump as long as we didn't go over our alloted medical equipment money (we didn't). In general they just didn't sound like they knew what we were talking about.

Before I call them fuming mad I would really like to make sure I'm understanding correctly that they have to pay for it under ObamaCare.

Ugh I'm so sick of this ins. company. They never know what they are talking about on the phone and I've had to foot the bill for several of their screw ups in the year we've had their ins. They like to jerk us around and drag their feet. *end rant*

[Steph Ed]

From reading my insurance overview on changes due to the new laws, they are to pay for 100% of breastfeeding supplies if it is medically necessary. What that means is, you need to get a prescription for a pump from your doctor. I talked with my Doc and he is going to write me one closer to my due date (Feb). I would think since you have already been using a pump, you should continue to do so, therefore, making it a medical necessity you get one. I've even heard mastitis can be a reason for needing one. So, I would call the Doc and get the script, then call the insurance company. And, I've learned that my insurance company reps don't really know much about this law since it is so new. All they could really tell me was what I read on my changes overview sheet during open enrollment.

[kaia.aline]

Some insurance plans (like mine) consider themselves grandfathered in and do not have to change to follow all of the new rules of Obamacare so you may need to look at your plan. Other plans do not have to start following this until the plan starts over so if your plan starts over Jan 1st you would need to call back at that time.

[Steph Ed]

Originally Posted by kaia.aline Some insurance plans (like mine) consider themselves grandfathered in and do not have to change to follow all of the new rules of Obamacare so you may need to look at your plan. Other plans do not have to start following this until the plan starts over so if your plan starts over Jan 1st you would need to call back at that time.

Yep, this too. I got lazy and didn't include in my post. I would just get a copy of benefits and read for myself The employees of the company should know what is going on, but that doesn't mean they do! It might also be worth calling back and speaking to someone different.

One last thing....if you have insurance through an employer, there might be a insurance liaison for the company you can contact.

[shortcake2386]

our insurance will cover a manual pump 100% lol. dd's covered an electric 100% bc it was medically necessary