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01-28-2013 at 5:27 PM
RussianMom...
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do you consider a pump to be "medically necessary"?

All you Americans got me thinking I need to research my own extended health care here in Canada. My plan states this:

  medically necessary equipment rented, or purchased at our request, that
meets your basic medical needs. If alternate equipment is available,
eligible expenses are limited to the cost of the least expensive equipment
that meets your basic medical needs.

I sent them an email and inquired about it. But in the meantime, do you consider a breast pump to be medically necessary? I mean, I could understand if AFTER you had your baby and you could not breastfeed for X reasons, that it may become necessary, but we all know how convenient it would be if the pump was ready beforehand.

Thoughts? 

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01-28-2013 at 5:43 PM
Bliss+Berr...
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It would really depend on the circumstance.  There are medical conditions which would render them medically necessary and obviously in those cases having one on hand would be a lifesaver.  That said, they can be easily obtained either through a hospital rental or just having someone run to Walmart or BRU, even Amazon could deliver one relatively quickly.  Barring a medical need, I'm not sure why you would need to have one "ready beforehand."  Every thing I've read and the LC I have spoken with says that pumping should avoided for the first couple of weeks until supply is established anyway.
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01-28-2013 at 5:55 PM
Bride-hild...
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I asked my midwife to prescribe me one, and she did. And I consider anything prescribed as medically necessary.
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01-28-2013 at 5:57 PM
RussianMom...
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Bliss+Berry:
It would really depend on the circumstance.  There are medical conditions which would render them medically necessary and obviously in those cases having one on hand would be a lifesaver.  That said, they can be easily obtained either through a hospital rental or just having someone run to Walmart or BRU, even Amazon could deliver one relatively quickly.  Barring a medical need, I'm not sure why you would need to have one "ready beforehand."  Every thing I've read and the LC I have spoken with says that pumping should avoided for the first couple of weeks until supply is established anyway.

if the insurance company covers it, it would just take a long time to go buy one, send in a claim form, and get your reinburstment - that's why it would be easier to deal with it now. I guess it just depends on what they consider to be medically necessary. 

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01-28-2013 at 6:09 PM
smilygrl17
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I think medically necessary might be if your baby is in NICU and you can't nurse, so pumping is the only option, or some other medical reason that you can't nurse, not because you want a pump to pump.
 
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01-28-2013 at 6:10 PM
mrsmcdonal...
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For the most part, pumps are for convenience, not medical necessity. Medical necessity would be for NICU babies, latch issues, supply issues, etc., which can't be determined until after the baby is here. There are pumps available in the hospital if there are difficulties, and like Bliss+Berry stated, you can get one pretty easily after the fact.

It would be for pure convenience to have one ahead of time; and I, too, was told to hold off on pumping until supply was well established, as breastfeeding is a supply and demand process - my pediatrician said to wait a month before pumping, so I definitely didn't need a pump ahead of time. 
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01-28-2013 at 6:17 PM
JenS2203
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DD1 would not latch for 3 weeks, so without the pump I wouldn't have been able to breastfeed. So, yes it can be medically necessary. I'm sure there are many, many other situations that would also cause the pump to be medically necessary. Now, of course there was no way to know beforehand that she wouldn't latch.
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01-28-2013 at 6:18 PM
SkyBee
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Only if you can not nurse for some reason.
 
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01-28-2013 at 6:29 PM
dande2129
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I think it's a grey area.... In my case, DS would not latch, at all, even with the help of numerous lactation consultants and yet, I wanted him to benefit from my breast milk. Without the pump, he would have gone straight to formula. With the pump, I was able to exclusively pump for 3 1/2 months before my supply tanked. But would DS have died if he were on formula? Nope.

At the same time, it's not like pumping is a walk in the park. It also takes a lot of work and diligence.  
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01-28-2013 at 6:38 PM
RussianMom...
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dande2129:

I think it's a grey area.... In my case, DS would not latch, at all, even with the help of numerous lactation consultants and yet, I wanted him to benefit from my breast milk. Without the pump, he would have gone straight to formula. With the pump, I was able to exclusively pump for 3 1/2 months before my supply tanked. But would DS have died if he were on formula? Nope.

At the same time, it's not like pumping is a walk in the park. It also takes a lot of work and diligence.  

ya that's the other thing.. hypothetically, couldn't an insurance company just say "feed your baby formula then" ??
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01-28-2013 at 6:49 PM
dande2129
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RussianMommy:
dande2129:

I think it's a grey area.... In my case, DS would not latch, at all, even with the help of numerous lactation consultants and yet, I wanted him to benefit from my breast milk. Without the pump, he would have gone straight to formula. With the pump, I was able to exclusively pump for 3 1/2 months before my supply tanked. But would DS have died if he were on formula? Nope.

At the same time, it's not like pumping is a walk in the park. It also takes a lot of work and diligence.  

ya that's the other thing.. hypothetically, couldn't an insurance company just say "feed your baby formula then" ??

Well, I guess that they recognize that breast milk is ultimately the best for the baby, and their logic is that a breast fed baby is typically sick less than a formula fed baby and they would therefore be saving themselves money in the long run. 

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01-28-2013 at 7:39 PM
OhSewCraft...
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I know for my insurance company, a pump is only medically necessary if the baby is in the NICU or has a medical condition that doesn't allow them to latch (not a bad latch or trouble latching, but like a clef pallet, etc.)

If BF just doesn't work out or you need to go back to work, they don't care - its not covered.


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01-28-2013 at 8:11 PM
RussianMom...
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i googled breast pump coverage in canada, and some ppl have gotten it covered (they have the same extended insurance company as mine) but didn't state that it needed to be medically necessary. so i guess it just depends on the plan. I will call tomorrow and confirm and my plan actually covers.
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01-28-2013 at 8:25 PM
mainerocks
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I was prescribed a pump while in the hospital b/c LO had a terrible latch. I don't feel like my insurance company was cheated. Could we have gotten by without it? Perhaps, probably with some formula. I do believe that in the end, the couple hundred it cost them was very likely easily made up by one less trip to the doctor later in his life (I BF for 14 months).
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01-28-2013 at 8:31 PM
Krissie201...
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Wow, you guys have a narrow opinion of medically necessary. If you are returning to work and would like to continue to breastfeed, then the pump is a necessity. Yes you can use formula, but it is well known that breast milk is best....

I'm in Canada as well and my insurance simply requires a doctors note to get one. No elaborate excuse or specific medical condition. My Insurance also has no issues with me ordering the pump in advance of the baby, so "Medically Necessary" is clearly a very loose statement. If they really wanted a specific medical reason then they would not allow pumps to be ordered in advance.
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01-28-2013 at 8:42 PM
mrsmcdonal...
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Krissie2013:

Wow, you guys have a narrow opinion of medically necessary. If you are returning to work and would like to continue to breastfeed, then the pump is a necessity. Yes you can use formula, but it is well known that breast milk is best....

I'm in Canada as well and my insurance simply requires a doctors note to get one. No elaborate excuse or specific medical condition. My Insurance also has no issues with me ordering the pump in advance of the baby, so "Medically Necessary" is clearly a very loose statement. If they really wanted a specific medical reason then they would not allow pumps to be ordered in advance.

For me, and I think for most who posted, it's not our *own* definition of medically necessary, it's what we've been told by our insurance companies. Prior to Obamacare mandating  pump coverage, my insurance company would not consider going back to work a "medical necessity" and required me to purchase my own. Is a pump necessary if your are breast feeding and returning to work? Yes, absolutely. But it's not a medical necessity.
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01-28-2013 at 8:49 PM
laurakaz13
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Yes.
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01-28-2013 at 9:01 PM
tokenhoser
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I would read that to mean they should cover a manual pump but are unlikely to cover an electric.
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01-28-2013 at 9:14 PM
MrsWindyCi...
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I don't know if I'd consider it "medically" necessary or not. Is it a necessity if you work and want to continue to BF? Absolutely. The thing is, if insurance companies and medical professionals believe that breast is best, and has health benefits, and try to get women to BF, then they should pay for a pump. You can't just bombard women with the idea that they should BF and then not support them with the tools they need to be successful - which, for many women, is a pump.

And FWIW, I didn't plan on pumping right away. I didn't buy a pump and wanted to just establish BFing to make sure it was going okay. DS had a hard time gaining weight, so I had to pump pretty much from the get-go (I ended up renting a pump and using it for a month before buying one). I pretty much had to, if I wanted to continue nursing him. 
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01-28-2013 at 9:26 PM
RussianMom...
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MrsWindyCity:

I don't know if I'd consider it "medically" necessary or not. Is it a necessity if you work and want to continue to BF? Absolutely. The thing is, if insurance companies and medical professionals believe that breast is best, and has health benefits, and try to get women to BF, then they should pay for a pump. You can't just bombard women with the idea that they should BF and then not support them with the tools they need to be successful - which, for many women, is a pump.

And FWIW, I didn't plan on pumping right away. I didn't buy a pump and wanted to just establish BFing to make sure it was going okay. DS had a hard time gaining weight, so I had to pump pretty much from the get-go (I ended up renting a pump and using it for a month before buying one). I pretty much had to, if I wanted to continue nursing him. 

FWIW, I didn't/don't want to breastfeed at all, but after we looked at our finances, we dont really have room to buy formula, so I don't really have a choice at this point. so I'm just going to try to BF & pump so that I'm not the sole feeder in this family and that I can leave baby w/food. 

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01-28-2013 at 9:48 PM
BoatsNHoes
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If your goal is to exclusively breast feed without ever introducing or supplementing with formula, then yes.
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01-28-2013 at 10:04 PM
OhSewCraft...
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Krissie2013:

Wow, you guys have a narrow opinion of medically necessary. If you are returning to work and would like to continue to breastfeed, then the pump is a necessity. Yes you can use formula, but it is well known that breast milk is best....

I'm in Canada as well and my insurance simply requires a doctors note to get one. No elaborate excuse or specific medical condition. My Insurance also has no issues with me ordering the pump in advance of the baby, so "Medically Necessary" is clearly a very loose statement. If they really wanted a specific medical reason then they would not allow pumps to be ordered in advance.

My insurance company, as with many others, does not deem going back to work as medically necessary. Its a "lifestyle choice."


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01-29-2013 at 12:04 AM
gimmietimm...
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OhSewCrafty:
Krissie2013:

Wow, you guys have a narrow opinion of medically necessary. If you are returning to work and would like to continue to breastfeed, then the pump is a necessity. Yes you can use formula, but it is well known that breast milk is best....

I'm in Canada as well and my insurance simply requires a doctors note to get one. No elaborate excuse or specific medical condition. My Insurance also has no issues with me ordering the pump in advance of the baby, so "Medically Necessary" is clearly a very loose statement. If they really wanted a specific medical reason then they would not allow pumps to be ordered in advance.

My insurance company, as with many others, does not deem going back to work as medically necessary. Its a "lifestyle choice."

Here's the rub, if RM is on EI, she will be off work for 52 weeks. If she's like the majority of new moms, she'll be ebf at home until lo is nearly a year - I don't know many that need to pump more than occasionally, it's not as common here because of the extended mat leave. Even if a lot of out extended health insurance covers it (mine direct billed to the medical supply store, I never bothered).
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01-29-2013 at 12:31 AM
RussianMom...
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01-29-2013 at 6:55 AM
Bliss+Berr...
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RussianMommy:

FWIW, I didn't/don't want to breastfeed at all, but after we looked at our finances, we dont really have room to buy formula, so I don't really have a choice at this point. so I'm just going to try to BF & pump so that I'm not the sole feeder in this family and that I can leave baby w/food. 

IMO, this sounds more like a convenience to you - not a medical necessity at this point.  Also, since you are in Canada, your leave is partially paid and significantly longer than the US, you could probably just use a manual pump which are much less expensive if cost is the issue.  
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01-29-2013 at 8:29 AM
mccall35
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Krissie2013:

Wow, you guys have a narrow opinion of medically necessary. If you are returning to work and would like to continue to breastfeed, then the pump is a necessity. Yes you can use formula, but it is well known that breast milk is best....

I'm in Canada as well and my insurance simply requires a doctors note to get one. No elaborate excuse or specific medical condition. My Insurance also has no issues with me ordering the pump in advance of the baby, so "Medically Necessary" is clearly a very loose statement. If they really wanted a specific medical reason then they would not allow pumps to be ordered in advance.

This exactly. I'm also in Canada, and I believe I just need a doctor's note/prescription to have my pump covered. 
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01-29-2013 at 8:29 AM
Krissie201...
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mrsmcdonald:
Krissie2013:

Wow, you guys have a narrow opinion of medically necessary. If you are returning to work and would like to continue to breastfeed, then the pump is a necessity. Yes you can use formula, but it is well known that breast milk is best....

I'm in Canada as well and my insurance simply requires a doctors note to get one. No elaborate excuse or specific medical condition. My Insurance also has no issues with me ordering the pump in advance of the baby, so "Medically Necessary" is clearly a very loose statement. If they really wanted a specific medical reason then they would not allow pumps to be ordered in advance.

For me, and I think for most who posted, it's not our *own* definition of medically necessary, it's what we've been told by our insurance companies. Prior to Obamacare mandating  pump coverage, my insurance company would not consider going back to work a "medical necessity" and required me to purchase my own. Is a pump necessary if your are breast feeding and returning to work? Yes, absolutely. But it's not a medical necessity.

 Canada is a completely different though
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01-29-2013 at 8:31 AM
dande2129
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Bliss+Berry:
RussianMommy:

FWIW, I didn't/don't want to breastfeed at all, but after we looked at our finances, we dont really have room to buy formula, so I don't really have a choice at this point. so I'm just going to try to BF & pump so that I'm not the sole feeder in this family and that I can leave baby w/food. 

IMO, this sounds more like a convenience to you - not a medical necessity at this point.  Also, since you are in Canada, your leave is partially paid and significantly longer than the US, you could probably just use a manual pump which are much less expensive if cost is the issue.  

This.

DS had to go to the hospital at 6 weeks old, and I didn't have my pump. (Forgot it in the rush) The hospital provided me a manual pump for free. We ended up being discharged before I had a chance to actually use it, but it was a nice Medela manual, and I wish I would have saved it for emergencies. 

I'd ask the hospital if they have a single manual pump. That's at least something. Worst case scenario is that they won't give you one.

I'd also try Craigslist if you end up not getting a breast pump covered. The electric pumps are expensive, but if you can get a used one, you just need to buy new parts that touch the breast milk, and those aren't really expensive and it's a one-time buy, usually. 
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01-29-2013 at 8:40 AM
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I didn't find having to wait and purchase the pump after DD's arrival to be inconvenient at all. The hospital had pumps available if I really did need it, and their's a better than any I could afford to purchase for myself. 

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01-29-2013 at 9:19 AM
Pearls+Oys...
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I'm in Canada as well, I will be on leave for 52 weeks and I plan to EBF for at least the first year, which means that having a pump would be nice, but not *necessary* (at least for now). Of course I'd like my SO to be able to feed our son as well, but even if it's covered, I'm not going to ask for a pump coverage, seeing as the manual ones really aren't that expensive, and I won't have a need for an electric pump. If I ever do, I can always buy a used one, and use brand new attachments, and call it a day.

I'm not big on insurance claims, I'd rather use them for *real* conditions and emergencies. I feel like enough people abuse our health system as it is.

Now if LO ends up in NICU or has a hard time latching for whatever reason, my tune might change. 
 
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