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Breast pump covered by insurance

post #1 of 9
Thread Starter 

Is this where I read (a while ago) about insurance companies covering breast pumps sometimes?  I can't find the thread if it is.  Has anyone had experience with this?

 

We just called our insurance company (Blue Cross of IL) and they said new plans since the healthcare reform act cover a low grade pump, but our plan is grandfathered in and doesn't.  Sounds weird to me. 

 

I have a Medella Pump in Style that I've used the last 4 times (for a year each time) so it's pretty worn even though I have replaced certain parts.  It would nice to get a new one.  I'll buy it anyway, I just want to be sure I don't take one person's word for it, when I've heard so much about it.

post #2 of 9

I might have been the one who posted about it.  I have Federal BCBS and it covered an Ameda Purley Yours double electric breast pump for me, I can order a new one on May 1st next year, it came with 90 freezer bags and I can order 90 more each month.  Hope this helps, mama
 

post #3 of 9

I have the same insurance as Tenk and got the same setup... I recently switched to the federal policy, though. That said--  I was on BCBS of Maryland until recently, and it would have covered it, too!

 

I know Spotty4 got one, too... maybe she'll chime in with her details.

 

I don't know about being grandfathered in to old policies... but I would think most insurance companies, if they don't cover the cost of a new pump, would cover the rental of a good quality one! I would certainly ask a lot of questions about that! Good luck!!!
 

post #4 of 9
Thread Starter 

Thanks for the info!

 

I'll make another call and see if I get the same answer.

 

BCBS is really annoying (although better coverage than many insurance plans I've had before.)  I wanted to add dental coverage a while back and even though it wouldn't change anything about our regular policy, they wouldn't let me add it while I'm pregnant.  How does that make sense?

post #5 of 9

There's no such thing as a plan being grandfathered in - the Affordable Care Act applies to all insurance policies (with a few relatively rare exceptions).  The act requires breast pumps to be covered with no co-pay.  However, there is a wide variety of compliance, as I am sure many of you have found!  But keep asking until you get a straight answer; maybe try asking your doctor/midwife or new mothers who you know have your insurance.  I know for us, our insurance only cover a hand pump, since the act does not specify anything about what kind or quality of pump needs to be covered.  So of course they go as cheap as possible, and a hand pump is pretty useless...

 

Good luck!

post #6 of 9

Yup, I have BCBS and it covered the Ameda Purely Yours at 100%.  All I needed was a Rx from my Ob that says "Breast Pump" and the store I had to purchase it through (not just any retailer) filed the bill and claim straight w/ insurance.  It was pretty hands off.  I kept the box unopened for a good 3-4 weeks until I got the processed claim in the mail saying I owed nothing.  I was a little suspicious - seemed too good to be true!

post #7 of 9
Quote:
Originally Posted by spotty4 View Post

Yup, I have BCBS and it covered the Ameda Purely Yours at 100%.  All I needed was a Rx from my Ob that says "Breast Pump" and the store I had to purchase it through (not just any retailer) filed the bill and claim straight w/ insurance.  It was pretty hands off.  I kept the box unopened for a good 3-4 weeks until I got the processed claim in the mail saying I owed nothing.  I was a little suspicious - seemed too good to be true!

Funny how each is different.  With mine I didn't need an Rx, I called, they transferred me to CareMark (or who ever fills Rx for them) and CareMark asked if I wanted manual or electric (I laughed) said electric and that was it ... it was that easy.  It came in the mail about a week later :)

post #8 of 9
Thread Starter 

Hmmm.  Seems like it would be worth another call!

post #9 of 9
Quote:
Originally Posted by easttowest View Post

There's no such thing as a plan being grandfathered in - the Affordable Care Act applies to all insurance policies (with a few relatively rare exceptions).  The act requires breast pumps to be covered with no co-pay.  However, there is a wide variety of compliance, as I am sure many of you have found!  But keep asking until you get a straight answer; maybe try asking your doctor/midwife or new mothers who you know have your insurance.  I know for us, our insurance only cover a hand pump, since the act does not specify anything about what kind or quality of pump needs to be covered.  So of course they go as cheap as possible, and a hand pump is pretty useless...

Good luck!

I was also told that my plan was grandfathered - meaning that there had been no significant changes to the plan or our payment since the Affordable Care Act was passed and therefore the plan was not yet subject to the Act. The intent was to allow consumers to keep their existing plans but also exempted those plans from having to comply until there was a significant change in the plan. I found this website that explained it further: http://www.healthcare.gov/law/features/rights/grandfathered-plans/
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