For years, an electric breast pump was one of the most wished-for items on every new mom’s baby registry. It was an item that was essential for every mom to have, but with a price tag of more than $300, it was often something moms couldn’t afford on their own, unless their friends pitched in together to get one for the baby shower.
Luckily, thanks to the Affordable Care Act, most insurance companies are now required by law to provide a breast pump for free for all new moms. However, which pumps they cover all vary depending on your insurance provider and your particular plan.
For example, some insurance companies only provide a manual breast pump, not an electric one. Others will only cover certain brands of breast pumps, or they may cover a pump up to a certain amount, and then it’s up to you to pay for the difference.
If your insurance does cover a breast pump, it will have to be purchased through a medical equipment company. You can’t just go on Amazon and buy a breast pump and then expect your insurance to reimburse you. It’s not gonna happen.
So how do you know which breast pumps your plan covers, and how do you go about getting one? Here are some basic steps you should follow:
Step 1: Contact Your Insurance Company
When you call your insurance company, first ask them if your policy covers an electric breast pump (procedure code E0603). If they say yes, then ask them what your insurance’s allowed amount is for the breast pump. In other words, exactly how much will they pay an in-network provider for an electric breast pump? (If you’d like, we’re also happy to call your insurance company and check your benefits for you. Trust us, we actually enjoy it.)
Step 2: Contact a Medical Equipment Company
Once you know that your insurance covers breast pumps, and you know how much they will pay for, you can then contact a medical equipment company and find out which brands and models of pumps you can choose from.
For example, currently at Neb Medical, we carry four pumps that are fully covered by Medicaid:
- Ameda Finesse
- Ardo Calypso Essentials
- Medela Advanced Personal Double
- Rumble Tuff Easy Express 2
If you have Blue Cross and Blue Shield HMO or PPO, you can choose from five pumps that would be completely covered:
- Ardo Calypso Essentials
- Ameda Finesse with Dottie Tote
- Medela Pump in Style Advanced Starter Set
- Spectra 9Plus
- Spectra S2 Plus
In addition, BCBS patients can also choose from three other more expensive breast pumps, but you would have to pay an additional fee.
If this seems overwhelming, don’t worry! We can walk you through everything over the phone.
Step 3: Research Breast Pumps
Once you know which breast pumps your insurance covers, you can then do a little research on each pump to decide which one fits your lifestyle best. Will you be transporting your pump to and from work? If so, you may want one that comes with a carrying case. Or maybe you are looking for one that has really strong suction, to make the pumping as fast as possible. Or, maybe the number of parts you’ll have to clean is a factor for you. Our suggestion is to read through a few blogs to get a feel for your favorites. (Here are some lists of best pumps from Mommyhood101, Babylist, and What to Expect).
You can also compare the features of different pumps on our website by clicking on the “compare” button under each product that you’re interested in.
Step 4: Get a prescription from your doctor
At your next prenatal visit, ask your doctor, nurse or midwife to write a prescription for a breast pump. Most OBGYNs should be very familiar with this, but just in case, make sure that the prescription includes the doctor, nurse or midwife’s name and signature, your name, the date, the request for a breast pump (the terms “breast pump,” “electrical breast pump” or “bilateral breast pump” are fine) and diagnosis code. To make it super easy, you can download this prescription form and have your doctor sign it. Prescriptions can be written up to one year after you’ve given birth. Once you have it signed, either email or fax the prescription to your medical supply company.
Step 5: Get your breast pump!
Yay! Now you’re ready to receive your breast pump. Once you give your insurance information and prescription to the medical equipment company, they will send out your pump right to your door. We typically send your pump about 30 days before your due date, just to make sure you have it in time. And if you need it sooner, we can get it to you in one to two business days, making it just as easy as ordering from Amazon Prime (but free!)
Have any additional questions about how to order a breast pump through insurance? Just give us a call.