How Do I Get My No-Cost Breast Pump?

Because of the Affordable Care Act most health insurance policies are required to cover the cost of a breast pump for mothers. This applies to all private health insurance plans (with the exception of grandfathered plans), Medicaid in certain states, and through the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in some instances. See (link to overview of ACA post) for an overview of the Affordable Care Act and its effect on maternity benefits.

If you have Medicaid, check with your Medicaid provider. If you cannot obtain a breast pump under these provisions in your state, contact the state’s WIC Breastfeeding Coordinator for help. 

If you have private insurance coverage, call your provider directly to confirm eligibility and the specific process for acquiring your no-cost breast pump. The process of acquiring a pump varies according to your specific plan and provider. 

Here are some questions to ask your insurance:

• Do I need a prescription or doctor’s order to get my pump? Are there specific codes that need to be included? Specific wording?
• Specifically, what type of pump is covered? (Manual or electric, double or single, hospital grade or regular, personal use or rental).
• Do I purchase the pump and receive reimbursement or do I use a network vendor or Direct Medical Equipment (DME) supplier?
• If I purchase the pump and receive reimbursement where to I submit the receipt? How long will the process of reimbursement take? 
• When can I begin this process? 

Ordering From a Network Vendor or Direct Medical Equipment (DME) Supplier: 

After confirming eligibility, your insurance company will provide you with the contact information or website for their contracted vendor or supplier. With a supplier like Byram Healthcare, you simply select the pump model you wish to order, the distributor contacts your physician to obtain the necessary documentation, and you receive your covered breast pump via mail within 7-10 days from order date.

If you believe your plan covers the cost of a breast pump, but your claim is denied please visit the following resources.

To file an internal appeal or an external appeal:

https://www.healthcare.gov/appeal-insurance-company-decision/external-review/

For other help: 

The National Association of Insurance Commissioners: http://www.naic.org/state_web_map.htm

The Consumer Assistance Program: https://www.cms.gov/CCIIO/Resources/Consumer-Assistance-Grants/

Sources: 

http://www.hhs.gov/healthcare/prevention/breast-pumps/

https://www.byramhealthcare.com/breastpumps/breastPumpOrderForm.php?back=no&mode=next

http://hygeiainc.com/requesting-a-breast-pump-from-your-health-insurance-carrier/

Our resident “Moms Who Know” informed this post and our writers composed it. No one contributing to this post is a trained medical professional. For further reading and information on familiarizing yourself with your breast pump, please visit the websites for any of the five brands Byram Healthcare proudly distributes:

https://www.medelabreastfeedingus.com

http://www.ameda.com/breast-pumping/getting-started

http://www.freemie.com/index.html

https://hygeiainc.com

http://www.spectrababyusa.com