If you have talked to anyone recently about getting a breast pump, you have most likely heard two things over and over. First, that you can get a FREE one through your insurance. So, you’re thinking SCORE!! But then they tell you that you can only get the exact one that your insurance tells you. Then you’re thinking…waiiitt, I really wanted a spiffy Medela Backpack Pump (because who says “no” to convenience when you have to pump, am I right?)! What a lot of new moms don’t know is that there are a few ways that can help you get that exact pump that you want!
Under the Affordable Care Act, companies are required by law to support mothers in their breast feeding endeavors by adding breast pumps and lactation consulting into coverage. The law says that these services should be covered 100% but you need to be informed about what that means for you on your insurance plan! When I had my baby, I did not know as much as I wish I had. So now I am here to let you in on some awesome things that I didn’t know!
WHERE DO I START?
You will first want to call your insurance company and your Health Savings Account (HSA), or Flex Spending Account (FSA) company. Not everyone has an HSA or FSA, so don’t stress if that isn’t familiar to you. Remember that every insurance plan is different. So, even though you and your friend might both have the same insurance provider, your plans could be different enough that your info might change just a tad. Always, always, always call! Even if you have had a baby before!
WHAT DO I ASK?
To ask your insurance company: Do I need to get a prescription from my doctor? What exactly is covered by my plan? Are lactation consulting visits covered? How and when do I get my pump (pick up at a store or is it sent to me)? Do I have to get the pump from a certain company/store in order for it to be covered? What type and brand of pump is covered (type: standard or hospital grade)?
To ask your HSA or FSA company: Can I use my HSA or FSA account to cover breast pump costs and lactation counseling? Do I need to get it approved beforehand/how do I get it approved? Do I need a prescription from my doctor?
Some plans will likely have more rules than others. When my daughter was born, my insurance company told me that I had to get a prescription from my doctor, and that I could only get my pump from one of the certain stores that was listed on a document they sent me. I am really glad I called beforehand because my doctor wrote the prescription for a hospital grade pump. Knowing beforehand saved me the time and hassle of having to go to the store only to find out that I needed my prescription to say something different. We got a pump without a problem, but it was just a verrrry basic pump that was really inconvenient to use. I also had no idea that I could even ask about getting lactation consulting covered. I definitely paid out of pocket for a few of those visits.
SO, HOW DO I GET IT ALL COVERED?
Okay here comes the information dump, so buckle up! I promise you will be happy you know all of this! Let’s get the lactation consulting out of the way. This is answered completely by what your insurance and HSA/FSA companies tell you. If your insurance company tells you that they will cover your lactation counseling, you will most likely have to see someone that is in their provider network. Many pediatrician and OB/GYN offices have lactation consultants on staff there so I would start by calling them and then calling your insurance company to make sure you are in the clear! Due to something called “grandfathered plans”, some providers don’t have to cover it. If this is you, then your insurance company should explain it to you, and you should contact your HSA/FSA representative. If you get a written prescription from your doctor for the lactation counseling (they will totally write you one, you just have to ask) then typically you should be able to submit it to your HSA/FSA to be paid for up front by them, or reimbursed to you if you pay for it up front. Make sure that you keep a copy of the prescription and any bills or letters from your companies for your records, just in case you ever get audited for anything!
Alright, let’s get into the breast pump madness here! There are SO MANY factors and different situations with these, so we are going to talk about the most common circumstances to give you a head start on your journey!
Start with what your insurance company tells you. In most situations they will cover one type of pump/or a certain dollar amount. If you do not want to use the pump that they cover, then you move on from there! This is where your answers start to become different, depending on your circumstances.
If you DO NOT have an HSA or FSA: Your best way to get the exact pump that you want is to find out the dollar amount that your provider will cover. You will also want to ask them to make sure that what I am talking about here is okay. You will still get a prescription written from your doctor. You want him to write it for the exact pump that you want! For example: Medela Pump In Style Advanced – On The Go Tote, should be exactly what your doctor writes if that is what you want! Then you pay the difference! To get your pump quickly, you might just pay for the whole thing, and submit your claim to your insurance. Then, once they have processed it, you can be reimbursed for the dollar amount that they cover. Again, make sure that your provider will do this BEFORE you go out and buy your pump!
My insurance company will cover $150, which is the cost of the pump that I got for free through them. Using this trick, I could, instead, get the On The Go Tote for only $120 out of my pocket. That is less than half the retail price!
If you DO have and HSA/FSA Account: You start just the same as above. First, make sure this process works with both your insurance and HSA/FSA companies. Get a prescription from your doctor written for the EXACT pump that you want. Have a copy for your insurance company, your HSA/FSA company, and for yourself! Submit your prescription to your insurance and HSA/FSA company for approval. Then you can purchase your pump and wait for the reimbursement from both companies. Your insurance will cover their specified dollar amount, and the rest is paid for out of your HSA/FSA account!