Wednesday, January 1, 2014

Affordable Care Act and Free Breastpumps: 8 Questions to Ask

So you've heard the buzz since 2012, but still aren't sure how the Affordable Care Act covers your breast pumping supplies. You're not alone. The requirement for all private insurance carriers (excluding Medicaid and WIC) went into effect August 2012. Although it sounds simple, each insurance company is allowed to tailor its contracts to cover breast pumping at 100% with certain LIMITATIONS. In order to find out what your contract will cover, you'll need to call the member services phone number on the back of your insurance card. Navigate through the auto-attendant until you can reach a real, live, breathing human being. Next, request that your call be recorded for later reference. (If your carrier has a members' website in which you can email member services about your specific contract, I would suggest that route since you'll create a beautiful paper trail.)

8 Questions Every Mom Needs to Ask...

1. What kind of pump does my contract cover: manual, single electric, double electric, AND/OR hospital grade?
        *Some contracts only cover manual pumps and you'll be expected to get anything fancier on your own dime. This is totally fair on the part of the insurance company since the ACA allows for them to write up any limitations they want to, but I agree, it's not very kind.

2. Does my contract cover breast pump rental?
        *Sometimes breastpump rental is more economical than purchasing. Check with your local hospital's lactation services for types/cost of pumps they rent and sell. Some hospitals rent the Medela Symphony for around $60/mo, whereas purchasing the pump outright would cost roughly $1000.

3. What is the dollar max/limitation on breastpumps with my contract?
        *All plans will have some financial limitation, despite the wording of breastpumps being covered at 100%! In our case, the limit was $150. Just because the limit is $150 does not mean that you can't get a more expensive pump; it just means that the insurance will only pay up to that amount.

4. Do I need to meet my deductible before the pump is covered?
        *Most likely, the answer will be yes. In this case, if you haven't met your deductible yet, the breastpump purchase will count toward your deductible. You could purchase your pump after your delivery if the cost of the delivery will enable you to meet your deductible. Remember that insurance processes by "procedure date", so even if you don't get your hospital bills until much later, your hospital claims are based on the date that you received services and the deductible will then be met retroactively (back to that date).

5. How do I go about acquiring my pump: the insurance company will send it to me, I need to order through a durable medical equipment (DME) facility and the DME will file insurance for me before I pay for the pump, OR I need to buy the pump outright and the insurance company will reimburse me through a claim I submit on my own?
        *It's great when an insurance carrier will mail your pump directly to you and complete all the paperwork. You can ask if you would need a prescription for the pump when going through a DME, but most likely the insurance company will not require a prescription since breastpumps are not covered under Prescription Services; the ACA has made breastpumps their own category.

6. If I need to order the pump through a DME or need to seek reimbursement after purchasing a pump at a retailer, what forms do I need to submit to the insurance company?
        *Make sure you get SPECIFIC form numbers. My BCBS carrier website has 4 different reimbursement forms --- only one of them will process correctly for breast pumps. They don't make it easy.

7. What address or fax number do I submit these forms to?
        *You'll need to follow-up with the insurance company after mailing or faxing to see that they actually received the paperwork. When I called BCBS a week after faxing my claims form for reimbursement, I was told that the fax number I was given (and had a paper trail and name to reference from 10 days prior) was no longer being used for claims faxes, and that I would have to re-fax to another number. If you get this type of run-around, don't be upset with your insurance carrier's staff --- it's typically a much deeper issue that boils down to "if the insurance company didn't get your stuff, they aren't responsible for it." You'll need to be the bull in this arena to make sure your paperwork is complete and processed correctly.

8. Can I order my pump prior to the birth of the child, OR do I need to wait until after his/her birth?
       *Most contracts/plans will allow you to pursue pump purchase/reimbursement prior to the birth of the child as long as the insurance company has received prenatal claims from your OB or Midwife's office (i.e., ultrasounds).

Final Thoughts...

Not all pumps are created equal. Pumping occasionally to provide just enough milk for a sitter requires nothing more than a manual hand pump. A single electric would get the job done more efficiently. If you plan on pumping after returning to work or pumping exclusively (in lieu of putting the baby to breast), you'll need something more substantial like a double electric or hospital grade. There are different varieties of double electrics, so do your homework. Here's a great article to reference that details each aspect of the pumps! Another resource are Pumping Moms' groups on Facebook (one is linked below) as well as message boards scattered about the internet.

I recommend Medela over all others simply because their pumps/replacement parts are more accessible, customer service is easy to access, replacement pumps will be shipped overnight if your pump breaks, and they get the best reviews for frequent pumping. We were able to purchase the Medela Pump In Style Advance Metro and receive reimbursement up to $150. After using a 20% coupon at Buy Buy Baby, some store credit, and the $150 reimbursement, the pump cost us $90 out of pocket. I love the size of the Metro. It's the only Medela double electric that is removable from the bag. It's easy to move around the house and comes with a battery pack if I need to be away from the wall, entertaining my toddler. With our first baby, we rented the Medela Symphony. It was massive and extremely heavy, but it was whisper quiet and very efficient. Again, you have to really determine what you're wanting out of your pump before investing! Don't skimp on research!

Helpful Resources...

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