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12-12-2012 at 11:30 AM
a13049
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Pump perscription

If you insurance is or will cover you pump and you need a perscription. Did you get one from OB or ask pediatrician for the perscription after the baby arrived

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12-12-2012 at 11:33 AM
kimmlet
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I called my insurance company and they said to go through my OB.

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12-12-2012 at 11:51 AM
jahjbmr
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I got it from my ob but have not done anything with it yet. I just told him "so insurance will pay for a breast pump if you write a prescription" and he immediately started writing it out. It just says breast pump for breast feeding

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12-12-2012 at 11:54 AM
Rose120
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I think it needs to be for a reason though...they told me to have my OB write "trouble feeding" or something on it so there was a medical need for the pump. I'm sure every insurance company is different though.
12-12-2012 at 11:58 AM
lizshort96
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According to my insurance, the OB will write and send the script to the medical equipment company who will then deliver the pump to our home.

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12-12-2012 at 12:08 PM
jobiann
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Mine is from my OB.


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12-12-2012 at 12:14 PM
bearkatjen
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I'll be getting it from my OB. I've already discussed, and it's no big deal.

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12-12-2012 at 12:14 PM
mrsjessica...
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Hey there ladies! I usually only lurk here, I post regularly on PGAL. Thought I would chime in my 2 cents here. I actually work for a medical equipment company in the billing office and do all our breast pump billing. Every insurance is going to vary in their medical policy, and it can even vary from plan to plan, depending on how it is underwritten.

Most plans will not cover a breast pump for a mom and baby who are both home and there are no feeding issues present. This is considered a convenience, not a medical necessity. However, if baby and mom are separated (ie- baby in NICU), most companies will pay for the rental of a "hospital grade" breast pump while the baby is in NICU. In this case, most ins companies will require additional info, like the History and Physical/ Admission papers for baby in NICU.

If baby is home, and there are feeding issues present, pumps can still get covered, but for this kind of coverage it is diagnosis driven. Most doctors will write a script for a pump and put a diagnosis of "Newborn Feeding Issues" which most companies will deny as the pump is billed under the mom, not the baby, and the diagnosis is only valid for a newborn. However, if your OB will write the script with a diagnosis of "Postpartum Breast Engorgement" or something having to do with the mother, then in most cases, the pump will be covered. There is a list of diagnoses that will get a breast pump covered, and anything outside of that list of diagnoses will get denied.

This will all be a moot point in 2014, when more of the "ObamaCare" regulations go into effect. At that point, breast pumps should be covered with no issues.

Sorry that was so long, ladies, but I wanted to let you know how it works behind the scenes, so to speak. Hope I was able to help someone out!


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12-12-2012 at 12:42 PM
lakreuz
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Got mine from my OB
 
12-12-2012 at 12:45 PM
Rose120
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Also, just a side note, but the company I went through said everything was fine and then my claim ended up being denied, so I told the company I would just pay for it out of pocket and it was $37. It wasnt even worth fighting over to get a $250-300 pump (PISA) for $37 so I just paid it. haha.

So even if you dont think your insurance will cover it you can try going this route?

Makes me wonder what the retail stores are making on this thing if that is the upcharge!! 

12-12-2012 at 1:12 PM
a13049
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I have confirmed that my insurance company will cover it, my plan has renewed and with the new affordable health care act my insurance company covers it 100 through a designated list of suppliers. In my insurance coverage it doesn't even list a need for perscription but the supplier is asking for it from a doctor and I was unsure if I should ask my OB or ped.

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12-12-2012 at 1:26 PM
beckajw
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My insurance company begins covering them in 2013.  I called and asked what I should do to get one and was told to have my OB write a prescription.

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12-12-2012 at 3:18 PM
a13049
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mrsjessicamitchell:
Hey there ladies! I usually only lurk here, I post regularly on PGAL. Thought I would chime in my 2 cents here. I actually work for a medical equipment company in the billing office and do all our breast pump billing. Every insurance is going to vary in their medical policy, and it can even vary from plan to plan, depending on how it is underwritten.
Most plans will not cover a breast pump for a mom and baby who are both home and there are no feeding issues present. This is considered a convenience, not a medical necessity. However, if baby and mom are separated ie baby in NICU, most companies will pay for the rental of a "hospital grade" breast pump while the baby is in NICU. In this case, most ins companies will require additional info, like the History and Physical/ Admission papers for baby in NICU.
If baby is home, and there are feeding issues present, pumps can still get covered, but for this kind of coverage it is diagnosis driven. Most doctors will write a script for a pump and put a diagnosis of "Newborn Feeding Issues" which most companies will deny as the pump is billed under the mom, not the baby, and the diagnosis is only valid for a newborn. However, if your OB will write the script with a diagnosis of "Postpartum Breast Engorgement" or something having to do with the mother, then in most cases, the pump will be covered. There is a list of diagnoses that will get a breast pump covered, and anything outside of that list of diagnoses will get denied.
This will all be a moot point in 2014, when more of the "ObamaCare" regulations go into effect. At that point, breast pumps should be covered with no issues.
Sorry that was so long, ladies, but I wanted to let you know how it works behind the scenes, so to speak. Hope I was able to help someone out!


Btw the affordable health care act went into affect aug 1st of this year, I understand that it won't nessicarily impact your coverage if it has renewed yet this year or if your plan gets grandfathered in, it doesn't have to wait till 2014. My coverage ha renews already, October 1st, and I do have coverage. I question how knowledgable you are about the subject, even if you do work for a medical supply company.

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12-12-2012 at 5:06 PM
BunnyBuni
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mrsjessicamitchell:

Most plans will not cover a breast pump for a mom and baby who are both home and there are no feeding issues present. This is considered a convenience, not a medical necessity. However, if baby and mom are separated (ie- baby in NICU), most companies will pay for the rental of a "hospital grade" breast pump while the baby is in NICU. In this case, most ins companies will require additional info, like the History and Physical/ Admission papers for baby in NICU.

This is illegal. Any plan that began or renewed in August of 2012 MUST cover the cost of a breastpump and breastfeeding classes. I had to spend 45 minutes fighting with my insurance company over it because they wanted to give me a crappy manual pump, but when I told them they either give me an electrical, give me a hospital rental or speak with my lawyer, suddenly a supervisor popped on the line and gave me the number for their medical supply agency and said, "It's a new law. Not everyone has been trained yet." And I told them that is BULL... this law went into effect 4m ago and was passed a year beforehand. EVERY woman should know that she has the right to a GOOD breast pump at no cost to her. If your insurance renewed after august, FIGHT for it. It may take an hour on hold or threatening them, but you will get it.


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12-12-2012 at 5:43 PM
cutemary00...
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I went through my OB.

 
12-12-2012 at 5:46 PM
a13049
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BunnyBuni:
mrsjessicamitchell:

Most plans will not cover a breast pump for a mom and baby who are both home and there are no feeding issues present. This is considered a convenience, not a medical necessity. However, if baby and mom are separated (ie- baby in NICU), most companies will pay for the rental of a "hospital grade" breast pump while the baby is in NICU. In this case, most ins companies will require additional info, like the History and Physical/ Admission papers for baby in NICU.

This is illegal. Any plan that began or renewed in August of 2012 MUST cover the cost of a breastpump and breastfeeding classes. I had to spend 45 minutes fighting with my insurance company over it because they wanted to give me a crappy manual pump, but when I told them they either give me an electrical, give me a hospital rental or speak with my lawyer, suddenly a supervisor popped on the line and gave me the number for their medical supply agency and said, "It's a new law. Not everyone has been trained yet." And I told them that is BULL... this law went into effect 4m ago and was passed a year beforehand. EVERY woman should know that she has the right to a GOOD breast pump at no cost to her. If your insurance renewed after august, FIGHT for it. It may take an hour on hold or threatening them, but you will get it.

This is almost true, some of the plans are grandfathered in.  If this is the case then they don't have to cover it. Also, some companies are able to opt out of offering the coverage because it conflicts with beliefs (mainly the birth control issue).  The law affordable healthcare act doesn't actually say what kind of pump has to be covered, which causes alot of confusion, it says breast pump supplies.  Definelty contact your insurance and if you feel like you aren't being given the correct information, or the representative that you are talking to isnt well informed then demand to talk to someone higher up.

I dislike the assumption of PP, that we are all SAHM wanting to get top of the line pumps, and that is a "convienience." If I was a stay at home mom, I would EBF and for the few occasions I needed to be away I could manage a manual pump.  

I called my insurance again, today. I feel like the original representative gave me short answers and led me in the wrong direction, I asked to speak to someone else.  My plan covers double electric personal use pumps, not hospital grades. This is considered a part of preventative care, I don't need a medical reason, but I do need a doctor prescription. If I have problems breast feeding then it becomes a medical neccessity and I can get a perscription for the hospital grade, and would need a perscription for that.  I'm guessing the coding would be different.  I was really happy to hear, because it is considered preventative I can order it before LO arrives. Not sure I will need it, but I would hate for them to go on back order or something and not have it when I need it, my maternity leave is only 6 weeks.

Medela website has some great questions to ask when you call your insurance companies to ask about coverage.


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12-13-2012 at 12:55 AM
sthomas122...
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Unfortunately, every insurance company is different. I plan on asking my OB for the Rx next visit. But when I talked to the guy on the phone and looking at my policy online, it does not say anything about needing a diagnosis or reason so not sure what the medical equipment place wants on my Rx... But the one pp who works for the company should know that not every insurance is the same. B/c my policy specifically states it will not cover a hospital grade pump at all under the "breastfeeding equipment coverage". And with the healthcare act it definitely has come into play already b/c my coverage rolled over in October and that is when this popped up under my benefits.

ETA: And it's a separate benefit under my durable medical equipment. With things like wheelchairs and whatnot I have to meet me deductible, I do not for the breast pump. 


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