Billing Breast Pumps To Insurance: A Guide For New Mothers

The cost of a breast pump can run into hundreds of dollars, so it's good to know that, thanks to the Affordable Care Act (ACA), new mothers are entitled to a free breast pump and supplies through their insurance. This legislation intends to help every mother have the opportunity to provide her baby with breast milk.

However, there are some variations in the type of breast pump covered by insurance providers. Some cover hospital-grade pumps, while others exclude them, and some only allow you to rent them.

Contact your insurance company to find out what type of breast pump they cover

To find out what type of breast pump your insurance company covers, it is best to contact them directly. There are no standard guidelines, so calling your insurance company is the best way to find specific details about your coverage. You can start by calling the Member Services phone number on the back of your insurance card.

It is recommended that you contact your insurance company by your third trimester. Most insurance companies have a dedicated maternal child specialist who can explain the process and the coverage to which you are entitled.

Before you make the call, it is a good idea to prepare a list of questions. Some of the questions you may want to ask include:

• What types of breast pumps do you cover? Some insurance companies offer a range of choices, including double-electric, single-electric, battery-operated, and manual models. On the other hand, some insurance companies only offer one or two options.
• Where can I get my pump? Most insurance companies require that you get your pump from an in-network provider, and there are usually several options to choose from. In-network providers may include durable medical equipment (DME) suppliers that operate online, such as Yummy Mummy or Aeroflow Breast Pumps, or retail outlets such as Walmart and Target.
• Do I have the option to upgrade my breast pump? Some insurance companies and DME suppliers will allow you to upgrade to a more expensive pump if you are willing to pay a portion of the cost.
• Do I need a prescription or pre-authorization to get a pump? Ask about this policy so that you are not scrambling to get a prescription from your midwife or obstetrician at the last minute. Even if you don't need a prescription, the DME or other providers may need to verify some information with your doctor before shipping your pump.
• Do you cover hospital-grade pumps? Hospital-grade pumps are more powerful than personal double-electric pumps, and most insurance companies do not routinely cover them unless there is a medical necessity, such as the baby being born tongue-tied, low birth weight, or the mother having a low milk supply. In these cases, you will need a prescription and diagnosis code from your doctor.
• Will I have to pay anything toward a hospital-grade breast pump? Hospital-grade pumps can be very expensive, and if you are eligible, the insurance will likely only cover a rental, not a pump that you keep. You may also have to purchase your own collection kit, which includes the tubes, valves, breast shields, and bottles needed to use the pump. Your costs will depend on your plan's DME coverage.

Ask if you can upgrade your breast pump

Upgrading your breast pump can be a good idea if you want a pump with extra features to make your breastfeeding journey more efficient and convenient. Some insurance companies and DME suppliers will allow you to upgrade to a more expensive pump if you pay the difference in cost.

How to upgrade your insurance-provided breast pump:

• Fill out a form – You may need to fill out a ""Qualify Through Insurance" form'', which will allow a specialist to verify your coverage, share your pump options, and file the claim for you.
• Contact your insurance – Your insurance provider will be able to tell you if you can upgrade your breast pump and how much this will cost. They will also be able to tell you if you can use your HSA or FSA accounts to pay the difference.
• Contact the supplier – Some breast pump suppliers, such as Aeroflow, will be able to contact your insurance provider on your behalf to discuss your options and let you know the cost of an upgrade.

Upgrading your insurance-provided breast pump can give you access to a range of additional features, including:

• A carrying bag in the form of a backpack, tote, messenger bag, or carryall
• An additional power source
• A cooler bag with an ice pack
• Hands-free pumping capabilities

Find out if you need a prescription

To find out if you need a prescription for a breast pump, you should contact your insurance provider. The Patient Protection and Affordable Care Act (ACA) requires insurance companies to cover breastfeeding support and equipment, but the specifics of what is covered vary from plan to plan. Some insurance providers will require a prescription for a breast pump, while others will not.

If your insurance provider does require a prescription, you will need to ask your doctor, OB/GYN, primary care doctor, midwife, or nurse practitioner to write one for you. This prescription may need to include:

• The signature of your OB/GYN and their NPI number
• Your first and last name, and your date of birth
• A procedure code (e.g. E0603 for a standard personal-use pump, or E0604 for a hospital-grade pump rental)
• An indication of medical necessity and an ICD-10 diagnosis code
• The date

If you don't have a prescription at the time of ordering your breast pump, some companies will coordinate with your doctor to retrieve the prescription on your behalf.

Check if your insurance covers hospital-grade pumps

To check if your insurance covers hospital-grade pumps, you should contact your insurance company. While the Affordable Care Act (ACA) mandates that insurance companies cover a breast pump and supplies at no cost to pregnant members or members who have recently given birth, the type of pump covered is not specified. This means that coverage varies depending on your insurance plan.

To find out what your insurance plan covers, call the Member Services phone number on the back of your insurance card. You can also ask your insurance provider the following questions:

• Do you cover hospital-grade pumps?
• Will I have to pay anything towards a hospital-grade breast pump?
• What do I need to do to qualify for a hospital-grade pump?
• How long will my insurance allow me to rent a hospital-grade breast pump?

Most insurance companies do not cover hospital-grade pumps unless it is a medical necessity. If you are unsure whether you qualify, you can contact your insurance company or a hospital-grade breast pump specialist, who will be able to advise on the specific requirements you will need to meet to qualify.

Ask if you will have to pay towards a hospital-grade pump

Hospital-grade pumps are more powerful than personal double-electric pumps and are usually only covered by insurance if they are deemed medically necessary. For example, if the baby was born tongue-tied, with a low birth weight, or the mother has a low milk supply. In these cases, you will need a doctor's prescription and diagnosis code.

Hospital-grade pumps are very expensive, costing up to $2,000, so if you are eligible, insurance will only cover a rental, not a purchase. You may also have to purchase your own collection kit, which includes the tubes, valves, breast shields, and bottles needed to use the pump. You may also have a deductible to meet before your coverage kicks in, as well as a co-payment. Your costs are determined by your plan's Durable Medical Equipment (DME) coverage.

If you are unsure about your coverage, it is best to call your insurance provider and ask about your specific plan.

Frequently asked questions