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 https://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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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 https://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.
Follow us on Twitter to get timely tips and tools to better understand how to use your health care plan.
And I work for a freaking Catholic hospital system!
