As my sister likes to say, "thanks to Obamacare, being a woman is no longer a pre-existing condition." Regardless of your political stance, it's nice that things like contraception and breast pumps are now mandatory to be covered under insurance policies without any copay (apparently some are grandfathered in/out, so check your policy).
There isn't a lot of info out there, so I thought I'd share what I've learned from talking to the insurance company - I have Aetna - and the medical equipment provider.
I spoke with Aetna this week. I am due 2/9/13, and pumps are covered
as long as they are purchased via a durable medical equipment provider
within 60 days
following the baby's birth. You can find the suppliers
via their DocFind website. Many of the providers I found do not carry
the same brands we're familiar with commercially at Target, BRU, etc, -- only the hospital grade brands.
However, Sunmed Medical carries Medela.
After talking to Sunmed (they are very helpful at navigating the process thus far!), here's what I learned:
- Can't order the pump until the baby is born, but they can provide you with paperwork that can be done ahead of time. Then, when you go into labor, give them a call and they'll get the order processed ASAP so that you have it within a few days of coming home.
- They don't currently have an arrangement to cover additional supplies (bottles, shields, nipples, etc), but that could change as they continue negotiations with the insurance providers.
- There are two pump options (see below).
COVERAGE:
Breast
pumps are covered under the new Affordability Health Care Act. Two
items must have occurred to qualify under this new provision:
1. Renewal date of qualifying* plans must have occurred
AFTER 8/1/12 and prior to the birth of the baby. Most plans
renew January 1. Please check with your employer to be sure. Not sure?
If you submit your information to us, we will check this as well.
2. Birth of baby must have occurred within 60 days of the receipt of the pump.
For
example, if your plan renews 1/1/13 and the due date is 5/15/13, you
would qualify, and we would just get the verification in place now.
Once you deliver, just let us know the baby
has delivered, and we will ship you the pump. If your baby is due
5/15/13, and your plan doesn't renew until 7/20/13, you would NOT
qualify, since your 60 day window would have passed from the time of
delivery to the time the plan becomes eligible under the
affordable health care act.
If you meet the qualifications above, the pump will be covered at 100% with no deductible or co-pay involved. If you do not
meet the qualifications above, the pump may be covered under
your medical policy, with all of the coverage criteria, deductibles and
co-pays of your health plan. We can also help sort through those
details as well.
There are two pumps that are eligible through this provider. With my personal insurance plan, I can pay $125 out of pocket to get the Medela Freestyle (vs the retail price of $350-$400!).
PRODUCT INFORMATION:
We carry only Medelea products, the most highly regarded breast pump technology in the world. They have developed the
Medela Advanced Personal Double Pump (APDP), designed for the
specific needs of the Affordability Health Care Act and Insurance
recipients, which is substantially equivalent to the
Medela Pump in Style, their retail product available at Target, Toys R Us, etc.
 |
| [Medela Advanced Personal Double Pump] |
The
APDP has the same motor as the Pump in Style, but comes with more
accessories than the Pump In Style, including a manual pump for
emergency situations. The Sunmed version of the APDP
also comes with a battery pack. Just insert batteries in the event
pumping needs to occur away from an electric outlet.
 |
| [Medela Freestyle] |
The Medela Freestyle
is available as an option, however, an additional cost would need to be
paid by the recipient, and not the insurance company. If this option
is your choice,
please contact us and we can provide you that exact additional cost.
Generally, it is about $150.00 additional, depending on your Insurance
carrier.
So, now what? Basically, you complete a form so they can begin the fulfillment process. If you can get your physician to write you a prescription for the pump, it may make the process move more quickly, but it isn't required. The form is pretty simple info - contact info, insurance provider info, and doctor's contact info.
GETTING STARTED:
To
get started, you would provide us your demographics and physician
information and we can start the process. If you already
have a signed prescription, please fax it to us,
along with providing us the demographic information below.
If you prefer, you can call us at 800-714-7434
M-F between 9 am and 5pm EST, and we can answer any additional
questions you may have, and we can take your information over the
phone. Or,
provide us your contact information and we can call you.
GETTING THE PUMP:
1.
Complete the form and email or fax it back to us at 800-715-5422, or call us with this same information
2.
We will verify your benefits and eligibility
3.
We will notify you of the information and coverage
4.
We will hold this information ready to go for shipment of your breast pump
5.
Upon
delivery, notify us of the delivery date, and we will ship the pump to
you.(Insurance company requires birth of child to occur prior to
shipment of the pump)
6.
Delivery is ground via UPS from Chicago, and should arrive within 7 days.
This is what I've learned thus far, so hopefully it'll help some of you mamas out there, too. I'm planning to get my paperwork submitted this week, and (crossing my fingers) it should be as easy as a phone call when I go into labor for the pump to magically arrive on the doorstep.
Of course, coverage & options may vary with each insurer and their approved medical suppliers. It's not too much hassle to save several hundred dollars, so that's a relief! You just never know with insurance sometimes!
**update 1/24/13: as luck would have it, my plan is actually "grandfathered OUT" of the Affordable Healthcare Act policies, so this process doesn't actually apply. Unfortunately, I won't be able to let you know how quickly the pump ships, works, etc. Instead, I just get to pay higher healthcare premiums without the benefit everyone else in the country receives. BUT...hopefully this info will come in handy for some of you. If not, check out
the best price I found on a Medela Freestyle breast pump here.**
