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Old Feb 19th, 2013, 17:28 PM   1
MamaFlick
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Breast Pumps covered by Health Insurance (U.S.)


I'm not sure if everyone knows this... I found out from a guy that I work with who just happened to read about it in a magazine. As of 1/1/13, private insurance companies have to cover breast pumps. I have Blue Cross health insurance through my employer. I emailed Anthem Blue Cross (California's Blue Cross) about this and here's the response that I got. On a side note - holy smokes, is the U.S. finally doing something good when it comes to heath care??



Thank you for your e-mail inquiry dated 02/15/2013.

You are covered for one breast pump per year. If you obtain the breast pump from an eligible in-network provider, it is covered as a preventative care benefit. If you use an eligible out-of-network provider, the breast pump is covered under your out-of-network durable medical equipment (DME) benefits.

In-network coverage is at 100% of the maximum allowed amount. In-network providers are required to accept the maximum allowed amount for services covered by your policy.

Out-of-network coverage is at 60% of the maximum allowed amount, subject to the deductible of $750 per person or $2250 for the family. Please be advised that an out-of-network provider can bill you for any difference between the maximum allowed amount and the actual billed amount. The out-of-network out-of-pocket maximum is $6000 per person or $12000 for the family. These totals include the deductible and coinsurance, but not any charges over the maximum allowed amount, penalties for non-compliance, copayments or non-covered services

To receive the full 100% coverage, the breast pump must be billed by a Durable Medical Equipment (DME) supplier who is in the PPO network, or by a professional or facility provider who is contracted through the PPO network to render this service. Please verify with the provider, at the time of service, that they are still contracted as PPO participating.

Please keep the following in mind:

• Only female members are eligible for this benefit.
• Breast pumps are covered as purchases or rentals. Hospital grade breast pumps are covered as rental items only, and are reimbursed at the rate of a commercial grade electric breast pump.
• A prescription is required for a hospital grade pump, when renting the equipment from an in-network DME company.

For your plan, I would suggest using EdgePark Medical Supplies (1-800-321-0591 or http://www.edgepark.com ) or Byram Healthcare (1-877-902-9726 or www.byramhealthcare.com ). These are in-network suppliers and are approved to supply a breast pump.

If you need further assistance, please feel free to e-mail us at your convenience.

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Old Feb 19th, 2013, 17:42 PM   2
Jcliff
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YES my dr told me this today. I am thrilled after seeing the price of pumps!



 
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Old Feb 19th, 2013, 17:42 PM   3
Scout
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With my insurance, I'm required to exclusively breast feed for the first 6 weeks and then I'll get one w/o having to pay anything. I'm so happy...one less expense!!



 
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Old Feb 19th, 2013, 19:17 PM   4
Bethi22
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I had no idea about this! Thank you for sharing!!



 
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Old Feb 19th, 2013, 19:21 PM   5
jazzylady
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Oh wow good to know



 
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Old Feb 19th, 2013, 20:24 PM   6
Jess137
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I called my insurance a few weeks ago and was told that my employer's plan doesn't have breast pump coverage And I work for a freaking Catholic hospital system!



 
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Old Feb 19th, 2013, 20:27 PM   7
tartlet
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Ladies who have United Health Care: I called and asked about this today and they require your baby to be born before they will ship your pump. The websites mentioned in the first post are in network. She said I would need a prescription from my doc for a double electric pump and why I needed it (returning to work after birth of child). She also said could be ordered in network from the doc or the hospital. Just don't go buy it at Target or Babies R Us and send in receipt because you won't be reimbursed. I am going to go ahead and ask the doc for my prescription at my next appointment and contact these companies to see if they can verify my info and have it on hold for when I deliver.



 
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Old Feb 19th, 2013, 22:00 PM   8
ILUVSHOPPING
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What!!! I'll have to check if Kaiser Permanete offers this!



 
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Old Feb 19th, 2013, 22:42 PM   9
Gabi1787
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With Blue Cross insurance plans you must go through Edgepark Medical Supply and you are eligible for a Medela Advanced Double Electric Pump. You can't order until you are no more than 30 days away from your due date but should receive it within a week. I just talked with them today! Hope this helps!



 
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Old Feb 19th, 2013, 22:52 PM   10
Hope1409
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Thanks for letting us know. Do any of you ladies know if Cigna covers this? I wish my cousin knew this a few weeks ago....she ended up borrowing a hospital pump for $40 per week. Not too bad but it adds up.



 
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