Monday, September 29, 2014

Getting a breast pump through health insurance

The cat wants to know how it's done.
I've written before about the new healthcare changes in the United States and how they affect pregnant women. One exciting change is the ability of any woman with a current health insurance plan to obtain a free breast pump, with the cost covered by the insurance company. Here's my experience with that.

I live in Washington state and have insurance through LifeWise, bought on the healthcare exchange since I'm self-employed. If you're employed with health benefits or covered under a family member's employer-sponsored plan, you're likely already on one of the newer plans. If you're freelance, you probably know whether you're uninsured or on an older, grandfathered plan (which are not required to meet all the new benefits, including this one), or whether you've purchased one of the new subsidized (depending on income) healthcare plans through the government marketplace for your state. Among the new rules of healthcare reform are a requirement that new plans cover maternity and newborn care (no pre-existing condition exclusions) and that they cover lactation consultation and either the purchase of a retail breast pump or the rental of a hospital-grade breast pump. (If you have Medicaid or WIC or a state-sponsored low-income insurance plan, the Affordable Care Act might not apply to you, but you can still get a breast pump through WIC or possibly your state's Medicaid program.)

Here are a couple quotes from an online pamphlet from the government summarizing the benefits of healthcare reform for breastfeeding parents:

Health insurance plans must provide breastfeeding support, counseling, and equipment for the duration of breastfeeding. These services may be provided before and after you have your baby.

Your health insurance plan must cover the cost of a breast pump – and may offer to cover either a rental or a new one for you to keep.

Your plan may provide guidance on whether the covered pump is manual or electric, how long the coverage of a rented pump lasts, and when they’ll provide the pump (before or after you have the baby).

[ "Breastfeeding benefits"]

I'll point out that lactation counseling and support is covered along with equipment. I'm not sure I'll need that this third time around, but it was invaluable during my initial breastfeeding weeks with my firstborn to have a certified lactation consultant (my midwife, in that case) visit my home, check my latch, and offer encouragement and support, considering the mess the hospital had left us to deal with. People with more severe breastfeeding problems will absolutely want to pursue some qualified lactation consulting. (Please, please, don't just assume the nurses or other hospital staff are the best advocates; check credentials and feel empowered to insist on calling in your own expert.) Talk with your insurance company if you want a lactation consultant, and talk with an established lactation consultant in your area about what the procedures usually are in regards to having your consultation covered by insurance. Your insurance website should have some sort of provider directory where you can look up which lactation consultants are covered in-network, or start here to find a certified consultant and then cross-check with your insurance company. Anyway, back to breast pumps, but keep that in mind if you need it!

The first step, if you're interested in obtaining a breast pump, is to contact your health insurance company. I looked at the general website through a Google search ("LifeWise breast pump" or something equally genius) and logged in to my account for the specific listing of my plan's benefits. I then called LifeWise and spoke to a dude at length about breast pumps and the terms of my plan. He was really professional about it, don't get me wrong, but I loved this actual quote toward the end of our conversation: "It's nice that you can rent a hospital-grade pump. That would really make it … uh … easier … for you to … uh … do your … stuff."

I had also Googled "breast pump insurance Seattle." Substitute Seattle for your choice of residential area, of course. (Or just move here. Lots of cool people here.) Lo and behold, the first search result that came up for me was Nurturing Expressions, which is literally across the street from my midwife. I looked at their site, and they provide in-network breast pump purchasing for all the major insurance brands hereabouts, including LifeWise. Score!

When talking with the LifeWise rep, he looked in the directory to make sure Nurturing Expressions was listed, and it was. He told me the basic rules for their coverage of breast pump purchases or rentals, and Nurturing Expressions (I stopped there after my 36-week midwife appointment) filled me in on the rest of the details. For what it's worth, here are the pump purchase rules for LifeWise:

(Pretty please keep in mind this is for current LifeWise customers only; your plan will probably vary, so check with your insurance provider!)
  • I can purchase a non-hospital-grade manual or electric breast pump, or I can rent a hospital-grade pump. Keep in mind that sometimes hospital pump rentals were covered pre-Obamacare, if there was proof of need (such as NICU baby, milk supply issues, etc.). But now you can choose which is best for you, in consultation with your healthcare provider(s) and lactation consultant, as applicable. My midwife summed it up like this: Off-the-shelf retail pumps will keep your milk supply going and allow you to collect milk for supplemental feedings or donations. Hospital-grade electric pumps will bring your milk in and are appropriate for people who need extra suction to start things off or keep up supply. Most of us can make do with the retail pumps, but you'll know or find out if you need a hospital-level pump.
  • If I buy a pump off the shelf at a retail location or online (which I am allowed to do), the LifeWise representative told me it would be considered an out-of-network purchase (might not be true — see my addendum at the end of the post); plus, I would need to submit a claim reimbursement form. I was confused whether the out-of-network part meant such a purchase wouldn't apply to my deductible and/or would be subject to higher coinsurance rates. I'd also had a problem getting a vision expense reimbursed once. So, to be on the safe side, I chose to purchase through an in-network provider (in this case, Nurturing Expressions) that could bill my insurance directly. To find a place local to you, as I mentioned, try a web search for your location plus something like "breast pump health insurance." Hospitals will be able to rent you hospital-grade pumps (um … duh, Lauren) and you can easily check if they're in-network for you. They might also have lower-grade pumps for sale.
  • LifeWise has a limit of $250 for how much they'll reimburse on the purchase price of a pump. That's a generous enough limit to get a decent double electric pump. If I chose to purchase a model above that limit, LifeWise would reimburse the first $250, and I'd be responsible for the rest. That's an option for people who need a particular model. Since I'm working from home and pumping mostly to provide rare supplemental milk for other people watching the baby, to make occasional breast milk donations, and to take the edge off any engorgement and oversupply, I don't need the fanciest of fancy models. But if you're working full time or have problems with low milk supply or need to pump a ton to supplement or donate, then it might be worth it for you to have an upgraded model. I let Nurturing Expressions guide me to their basic model, and I'm sure it will be fine (an upgrade for me, in any case, from the single-side manual pumps I've used till now).
  • For LifeWise, pumps worth more than $500 require prior authorization. I'm assuming this would be akin to buying a hospital-grade pump. I knew I didn't need that information so didn't inquire any closer, but be aware that if you're looking at renting a hospital-grade pump long term, you might require or be motivated to get a health care provider's prescription for buying the pump instead to save on rental fees. Check with your insurance company to find out what the rules are and what sort of authorization you'll need.
  • Nurturing Expressions offers only a limited variety of pumps. They do offer rentals of hospital-grade pumps that can be brought to the hospital after delivery. The ones they have available for purchase are all manufactured by Medela, which is a popular brand, though a WHO Code violator for their advertising of bottles and artificial nipples. (You can read Medela's own statements here. For me, WHO Code compliance is an important yet complicated issue when it comes to breast-pump companies that otherwise support breastfeeding and the use of human milk.) If I'd wanted a breast pump by a company that's WHO Code-compliant (Hygeia and Ameda currently are, as far as I know, though Ameda's switched back and forth in the past), I would have to make an out-of-network purchase at a retail store and it was very unclear to me from talking with the LifeWise representative if I'd have to pay for it mostly or entirely out of pocket. So there could be a compromise involved as there was for me, and you have to decide what's right for your financial and pumping situation. The cheapest model offered by Nurturing Expressions and covered by LifeWise is the Pump in Style Advanced Breast Pump Starter Set, which is what I received. They also offered Advanced and Freestyle models that gave more mobility and storage options to mothers who need to pump elsewhere (such as at an office or school or in the car); again, the increased price of these models would likely not be fully covered by insurance, but the upgrade might still be worth it for those who need those features. I'm not promoting any of the pumps I've mentioned since I haven't used them and since Medela is a violator of the WHO Code; I'm just pointing out that even within the limits of your insurance company's offerings, there will likely be upgrades available for an additional price. Some insurance companies might cover only the cost of a manual pump, for instance, when you may want an electric. Note that it might be cheaper to buy an upgraded pump at a retail location (perhaps on sale) than through an in-network provider, if your insurance company will cover at least an initial amount. According to some Yelp comments for Nurturing Expressions, at least one buyer of an upgraded model was able to get it for only $30 over the insurance payout amount, rather than the $100 Nurturing Expressions was offering, so it can pay to comparison shop if an upgrade is an issue for you.
  • I was able to buy the pump before the baby was born. Technically, I could still be breastfeeding my three-year-old (we weaned during this pregnancy), so I figured I could challenge any policy with that point, but I didn't need to. LifeWise and Nurturing Expressions both said it was fine to get the pump early, which is nice since it will be there if I need it right away (to help bring in my milk or, conversely, help with oversupply) and I won't have to make a hurried outing (or have Sam do it) to get a pump during those early postpartum days. The statement, though, said that many insurance companies will not let you get a pump until the baby is here, so be sure to ask! And if you're a first-time breastfeeder or have had a history of breastfeeding problems, you might want to wait anyway, to find out if you need a hospital-grade pump rental instead. I'm not sure what the rules are of doubling up with a purchase and a rental; one might not be covered in that case, unless maybe you have a prescription for the rental. For my part, Nurturing Expressions' return policy is that pumps paid for by insurance are nonreturnable. However, if you use a retail store and hold off on making your insurance claim, you could potentially buy a non-hospital-grade pump in advance, keeping it all sealed and ready to return in case it turns out you need a hospital-grade pump instead. Check the return policy of the provider, and aim toward the end of your pregnancy if there's a limited return window. If you have to wait till after the birth, contact your in-network breast pump provider to see if you can set up the delivery, purchase, or rental to go through immediately after by just contacting them at that point. You might be able to fill out the forms in advance and choose which pump you'll want.

My time at Nurturing Expressions lasted all of five or ten minutes. I filled out two short forms; they took a copy of my driver's license and insurance card; and the customer service woman there asked me some questions about what I needed from a pump and helped me select the cheapest model (as discussed above). She then explained the functions of the pump and how to clean it. She gave me a handy refrigerator magnet with breastmilk storage guidelines as well as a copy of the documentation and sent me on my way, my new little pump in a box under my arm. It was so freaking easy. They also had hands-free pumping bras, lactation cookies, compression stockings, birth supplies, and other fun goodies for sale. My kind of store! They also have certified lactation consultants on staff. If you are local to Seattle, I'd recommend you check them out (and, no, I'm not getting any cool kickback for saying so).

Here's something I like to point out, to counter the "breastfeeding" aisles at stores that are 90% pump-related: Breast pumps are not necessary for all breastfeeding parents. If you plan to be near your child until the end of your exclusive-breastfeeding period (at least six months, which has been my case as a work-from-home mama), and if you have no difficulties establishing and maintaining a milk supply, a breast pump is an optional addition. Even if you want one, you can probably make do with a manual pump or Milk-Savers for occasional collection. Once the baby's at least six months, you could even leave solid foods and a little bit of water for short periods if absolutely needed, and babies over a year can have alternative milk sources. But, if you plan to work out of the home or otherwise have a need to leave your young baby for long periods, but want to continue feeding expressed milk (which is a great idea!), then you'll want to look into a double electric pump for sure, for the ease and speed of collecting the milk you'll need. There are other reasons to pump, such as for establishing or continuing milk supply, collecting in advance of a planned surgery or to take a medication, help with engorgement, and human milk donation. Speak with your healthcare provider or lactation consultant for guidance on whether pumping is recommended for your situation and what kind of pump is best for you. And even for those of us in that first camp of not needing an electric pump, it's nice that it's now an affordable option, thanks to the new health insurance laws!

[Update, which I waited for before posting!]

I've received my completed statement of benefits from LifeWise with Nurturing Expressions listed as the provider. The pump went through at $250, completely covered by LifeWise. My responsibility, according to the EOB, is $0. I still haven't met my yearly deductible, so for me at least, the pump seems to have been covered in full and not subject to the deductible or coinsurance.

This is contrary to what the LifeWise representative told me on the phone (and better). He'd mentioned a breast pump would count as "durable medical equipment" and be subject to the deductible and in- or out-of-network coinsurance. Now it appears I might have successfully been able to buy a different pump (from a different company, as desired) at a retail location and had it reimbursed in full if under $250. I don't mind the pump model I have, but I'd have prioritized a WHO Code-compliant company if I'd thought I had the choice. It's a little discouraging that I did call and tried to get full and accurate information and couldn't, but it's nice that everything went through correctly, anyway. I'd recommend talking to your insurance company, a provider in your area, your healthcare professional (if informed on the subject), and maybe talking again to your insurance company in case another rep knows more….

So that's that! I'll try to update if there are any new surprises.

Leave your own comments of your experiences with securing a breast pump through insurance, and any tips for how to have it go smoothly.

My cat claimed the pump box for her own.

Note: Even though this post mentions various brands by name, no incentives changed hands, and no affiliate links were used till now. I pay for my own health insurance and used a local provider for my breast pump purchase through the insurance company. I am (clearly) not an expert in health or insurance and am just sharing my own experiences. If you'd like to support this site at no cost to you and don't yet have health insurance, I'll offer you my affiliate link to eHealth, where you can compare and purchase current health insurance plans for you and any family members.

Photo credits: Top: Quinn Dombrowski; Bottom: Hobo Mama


Anonymous said...

Great, thorough post!

I got a pump covered in full by my insurance. They wouldn't let me order it until after the birth, though, so I bought a manual pump as well. (With my first baby, I was really glad to have a manual pump when I was hospitalized with a foot injury: I didn't have to find a conveniently placed power outlet, and I was able to get from home to hospital alone on crutches carrying the pump.)

My insurance offers ONLY the Medela Pump-in-Style Advanced. I'm sorry to read about the downside of Medela, but I am happy with the pump, which I use every weekday as I work outside the home. I also have an older PIS that I got from a friend, used for my first child, loaned to another friend, and got back again--it fed 6 babies in all!--but I'm glad I listened to my LLL meeting's advice to get the new pump because it's much faster and more effective.

The only thing that really bugs me is the insurance statement indicating that they paid over $400 for this pump that sells for $250 at Target!! Wouldn't you think they'd get a bulk-buying discount?! That extra cost is no doubt adding to the cost of my insurance plan, which OCTUPLED over a decade and is going up again next year....

The coverage of lactation consultants is a great thing. We got lots of help when Lydia was puking blood, at no extra cost.

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