How to get a breast pump reimbursement from your insurance company

mom calling insurance company about breast pump reimbursement

How to get a breast pump reimbursement from your insurance company

Thanks to the Affordable Care Act (ACA), insurance providers must cover breast pumps. While this is certainly a better deal than moms once had, it’s still not always ideal. Not all policies provide the same coverage, and different policies may have different guidelines on the types of breast pump covered. In some cases, the insurance company pays outright, whereas in other cases, they reimburse you after you make the purchase. With so many factors in play, figuring out your provider’s specific benefits and processes can be confusing and frustrating.

What does the Affordable Care Act entitle mothers to in terms of breastfeeding?

Moms are eligible to receive breastfeeding equipment, supplies, and even lactation support under the ACA. Exactly what breastfeeding equipment is covered depends on your doctor’s recommendation, but in general, it includes a double-electric breast pump per birth experience, pump parts, and breast milk storage supplies, like bottles and bags.

Here’s where breast pump coverage gets confusing.

While ACA guidelines are pretty clear, there’s some room for interpretation, and many insurance companies take advantage of this. They might require a prescription from your doctor before the purchase or require you to submit a receipt afterwards for reimbursement. They may require you to purchase your breast pump from an in-network durable medical equipment (DME) supplier or only purchase a particular brand or model. In some cases, they may make you wait until after delivery to purchase your pump, and some providers don’t have to cover your pump at all if the plans were written before the law was passed.

What’s a mom to do if her breast pump coverage is confusing her?

Unfortunately, if you’re not sure about your plan’s requirements, guidelines, and coverages, you’ll have to call to confirm. Unless you’re purchasing through Milk N Mamas Baby. Not only are we a DME supplier, we’re in-network partners with a variety of other insurance companies, including Tricare, BlueCross BlueShield, UPMC Health Plan, and Health Partners Plans, to name a few. We’re also happy to advocate for you. We can call your insurance provider to confirm your coverage, so you have one less thing to do.

What if the pump you want isn’t covered by your plan?

While standard double-electric pumps like the Spectra S2 are commonly covered, so-called premium pumps, like the Elvie Pump, may not be fully covered. However, your insurance provider may reimburse you up to the amount your plan does cover. If you have a flexible spending account (FSA), a health savings account (HSA), or a health reimbursement account (HRA), you may be able to use that to cover a premium pump.

Submitting your claim for breast pump coverage and reimbursement

Once you’ve gotten your prescription and decided on your pump, it’s a matter of filing your claim promptly and submitting your receipt. Once again, Milk N Mamas Baby customers can leave this step to us. We’ll submit your prescription, claim, and necessary receipts to your insurance company, so you don’t have to.

If you’re an expectant mom with enough on your plate already, leave the insurance part of your breast pump buying experience to us. We’ll confirm your coverage, get your prescription, and even file your insurance claim to save you valuable time.

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