The Good News:
Under the federal Affordable Care Act (ACA) of 2010, insurance companies are now required to cover the costs associated with breastfeeding, such as breastfeeding pumps and lactation services, without a copayment or co-insurance to meet your deductible so long as the services are “in-network.”*
The Bad News:
The language of the act is a bit vague and so insurance companies are setting their own specific policies about what is covered and how to go about procuring the breastfeeding support services and supplies you need.
This has created much confusion about the law and what it means to mamas. We are here to help you understand your rights and advocate for the benefits to which you are entitled by law.
Call your Insurance Company First
Contacting your insurance provider is the first step in understanding what breastfeeding-related coverage and benefits you are eligible for. Generally speaking, lactation consultants typically fall under preventative care, while breast pumps are considered medical supplies.
We’ve seen mamas get lots of different answers from their insurance providers about what is covered. Some will cover hospital-grade pumps, while others only cover hand pumps. Some have specific brands of pumps they will cover, and many require that you purchase such pumps at specific medical supply locations. This is due to their “in-network” requirements.
It’s best to call your insurance company before your baby is born (but, of course, its not too late once they’ve arrived). Your insurance card should have the company’s toll-free member services number on the back.
Questions to Ask about Breast Pumps:
- What type of pump can I get? (hospital-grade rental pump, double or single electric personal-use, battery or manual pump)
- Do I have brand options?
- Do I have to get the “recommended” pump or can I choose to purchase one (aka “out-of-network”) and submit the receipt for reimbursement?
- If yes, what amount will I be reimbursed? Is there a dollar limit on coverage for breast pumps?
- If I have already obtained a breast pump, can I submit a claim for reimbursement?
- Do I have to get the breast pump approved first?
- When can I get my breast pump? Before giving birth? After the birth of my child(ren)?
- Where can I get my breast pump? Does it have to be from a designated place (aka “in-network” provider) or can I choose where to get it?
- Do I have a rental pump option? Do I need a prescription for proof of medical necessity?
Questions to Ask About Lactation Consultations:
- Is there a limit on the number of visits with a lactation consultant?
- Do I have to get the lactation visits approved first?
- Where can I receive lactation counseling services? Are there approved in-network providers? Can I get reimbursed if I use a lactation counselor out-of-network?
Medela has great tips on talking to your insurance provider, especially if you encounter difficulty getting the coverage provided by law.
Contact the Medical Supply Providers or Lactation Consultant
Once you have obtained a list of “in-network” providers, it’s a good idea to contact the medical supply providers your insurance company gave you. Ask them about what types and brands of breast pumps they carry and if there are any specific requirements related to obtaining your desired pump as covered by insurance. For example, some medical suppliers will not allow you to obtain a pump prior to birth. Some will let you pick up the pump, while others will deliver it to your home.
Same goes for lactation consultants—be sure to call the ones your provider gave you to get details about the services they offer.
Breast Pumps and Minnesota Care
If you are receiving Minnesota Care you may also be eligible for coverage. The same recommendations apply: call your insurance company first and then call the medical supply providers. (You may also have to contact your Minnesota Care caseworker.) Make sure the medical supply provider is aware that you are covered under Minnesota Care, as this can affect the type of pump you are eligible to receive.
Getting Help Getting Covered
If your insurance representative doesn’t give you the answer you’re looking for, ask to speak to a supervisor. If that doesn’t work, tell them your going to file a request for assistance with the Department of Insurance. Often, this is enough to prompt action. If not, the Department of Insurance can be of assistance. They can be reached with questions at 1-800-657-3602 or 651-296-2488. Select the Insurance option (choice #1) on message menu to speak with an insurance investigator who can assist you.
Wishing you a smooth and easy experience obtaining the breastfeeding support services and equipment you need!
*Note: This federal law covers private and commercial insurance carriers but does not cover Medicaid or WIC.