By Kelly Youngblood
Thanks to the Affordable Care Act that was passed in 2010, breast pumps are now covered by insurance companies. For the most part.
But that doesn’t mean every nursing mother who is insured and wants a breast pump will get her first choice for free.
Getting your insurance to cover a new, quality breast pump can be a long and confusing process says Heather Ludwig, Nutritionist and Lactation Consultant, at the Champaign Urbana Public Health District.
“This became a law but the guidelines are not incredibly specific,” Ludwig said. “There are no set standards that these insurance companies (have to follow).”
The bottom line, Ludwig says, is different insurance companies cover different things and some of them are better than others.
The law states insurance companies have to provide “breastfeeding services and supplies.”
Ludwig says that vague definition is where some moms can run into trouble because the law doesn’t spell out the specific kinds of supplies that are covered.
Some moms are discovering that while their insurance company technically covers a breast pump, it’s only a hand or manual pump and not a double electric breast pump (a quality double electric breast pump will cost around $200.)
That isn’t ideal for nursing moms, according to Ludwig, who feels a double electric breast pump is what most moms need to be successful at breastfeeding after they return to work.
“You’re setting (nursing moms) up to fail by giving them something that’s not going to work,” Ludwig said.
Ludwig encourages moms in that situation to ask their insurance companies if a better pump would be a covered with a co-payment.
Valerie Grindley of Mahomet was able to get a $300 breast pump for $60 through her insurance provider, Health Alliance. Because she had already met her $1,050 yearly deductible, the pump was covered at 80 percent.
“For me, I was satisfied because I had all the information beforehand and knew what to expect,” Grindley said.
While Grindley says she was happy with the price she paid for the pump, she wished she could have gotten the pump before delivery. “But that is not how the system works,” she said.
Grindley’s advice for moms getting ready to go through the process? Know whether or not you’ve met your deductible. Once you know it’s covered, make sure to check out your pump options. And have the discharge nurse call to verify that the prescription for the pump was received and ready for pick-up before leaving the hospital.
Some moms may find that their insurance companies won’t cover any breastfeeding equipment because they have “grandfathered plans” that haven’t been updated since the Affordable Care Act was passed. In that case, moms won’t get any coverage for breastfeeding supplies.
Ludwig said a denial of coverage can always be appealed. This link will give you more information about the appeals process.
If you are feeling overwhelmed by the idea of talking to the insurance company yourself, Ludwig says there are other resources out there that can help you navigate your way through the process.
First, if possible, talk to a Human Resources specialist at your place of employment. They will likely be able to find out the information you need.
You can also contact breastfeeding supply companies such as Lehan’s in DeKalb. Ludwig said they will know what questions to ask and can do all of the legwork for you.
Ludwig said advocating for yourself sometimes means asking someone else for help and there are many resources to choose from in this community.
“We are very blessed to have a very robust breastfeeding community (that offers) support,” Ludwig said.
She recommends contacting the local La Leche League, WIC at the CUPHD, Carle Breastfeeding Clinic and Presence Breastfeeding Services for more help.
While it might not be a walk in the park getting your insurance to cover a good, quality breast pump, it is possible. But moms will need to do their homework.
“It might not be that its easily laid out for these moms but they’ll get there and that’s going to help them on their way when they have to go back to work,” Ludwig said
For more information about how insurance companies are measuring up, go to the National Breastfeeding Center where you can find a model policy and a Breastfeeding Policy Scorecard.