We’ve said it before and we’ll say it again, getting a breast pump through insurance isn’t always simple. In the US there are over 900 different insurance companies as well as all types of insurance policies, and what you are signed up to, can sometimes determine what breast pump you can get. Since there are no set guidelines for insurers, calling your insurance company will be the easiest way to find specific details about your coverage.
Before you look into the details of your insurance policy, it will also be worth doing some of your own research. So here are some things to consider.
What you need to think about
You will have to choose between a manual, electric, or wearable breast pump. Electric breast pumps do the hard work for you and allow you to express milk quickly while manual pumps are easy to use and an ideal choice if you want to express milk for one feed a day.
Some insurers will only cover hospital-grade pumps – they’re breast pumps designed for mothers with a medical necessity preventing them from properly breastfeeding their babies and have a stronger breast pump suction.
You can also choose to rent a pump. Sure, it’s a more sustainable option, but if you’re on your first baba and plan on having more, owning the device might make more sense.
Getting what you need
As soon as you realize you’re pregnant, your mind will be swimming with questions (and probably not many answers) about what you need and how to get it. Sorting out your breast pump through insurance during your third trimester will take a weight off your mind when the baby’s born and mean that you’re ready to hit the ground pumping as soon as they arrive. So here’s how to do it.
Check with your insurer which DMEs they work with, then you can cross-reference what they sell and start making some decisions.
Clarify whether you need a prescription or pre-authorization for your pump.
Look into the cost of things because some hospital-grade pumps are expensive.
Have a read through some forums, message boards, review sites, and videos that might make you feel more comfortable with your choice.
In the last few years, breast pump innovations have been coming along a great deal (you only have to look at Elvie Stride to know that). So don’t settle for something that’s not right for you.
Don’t settle, mama
As you probably know, health insurance isn’t always 100% straight forward and it can feel like you’re doing a lot of hoop-jumping to get to where you need to be. If you think that your plan covers the cost of a breast pump, but your claim is denied, you have the right under the Affordable Care Act to an internal appeal or external appeal. It might be because you’re on an old insurance plan, so make sure it’s all up to date. If you need more help, contact your state's Department of Insurance or Consumer Assistance Program. Go to https://www.healthcare.gov/what-are-my-breastfeeding-benefits/ for more information.