The Affordable Care Act* mandates that covered health insurance plans provide support for breastfeeding and access to breastfeeding supplies. As a result, many women have questions about what their insurance company will provide. We have been working to find out information from insurers for over a year, and we still have many questions. Here are some guidelines based on what we have learned, and what we have heard from you, our customers.

What do you need?

First, think about what needs you have to support your breastfeeding. Do you need to take a prenatal class? Have a lactation consultant come to your home? Get a hospital grade breast pump? If you have benefits, you want to be sure they will be what you need.

What benefits does your insurance provide?

Call your insurance provider to find out what options are available to you. Here are some sample questions:

  • What lactation services are provided? Prenatal class or visit? Postnatal visits?
  • Who can provide these services? Do they have to be in-network? If out of network, what are the benefits?
  • Can I get a breast pump? Rent or purchase? What type (do I have a choice)?
  • How do I get the pump? Can I buy one I choose and submit for reimbursement? Can I get it locally, or does it have to be shipped to me?
  • When can I get the pump-before birth, after birth, before baby is a certain age?

 

If you need a pump

First, determine what pump will suit your needs best. A “free” pump is of no use if it isn’t the pump for you. We have had more than one mom come in to get a hospital grade pump after her “free” pump did not work and she is struggling with supply. Or buy another pump because the first one didn’t do what she needed. It is easier to establish and maintain than rebuild a supply.

Call your insurance company with these questions:

  • Do I have coverage for a breast pump?
  • What kind can I get (typically defined as manual, electric or hospital grade). Can I rent or buy?
  • Within this category, do I get to choose the type of pump I want? If so, what is my coverage amount (dollar amount)?
  • Do I have to use a network provider? What are my out of network benefits? If there is not a network provider in my area, what are my options?
  • Can I buy the pump I want and submit for reimbursement?
  • When can/should I get my pump?
  • Do I need a prescription? Do I need preauthorization?

 

If you need a lactation consultation or breastfeeding class

Prenatal breastfeeding classes or consultations can help you learn what to expect when getting started breastfeeding, as well as signs that you need more help. After baby comes, a lactation consultant can work with you individually to make sure breastfeeding is going well at any stage. In our experience, lactation consultations are often covered, at least in part, by many insurers.

  • Do I have coverage for a lactation consultation?
  • Who can I use for these services?
  • Do I have to use a network provider? What are my out of network benefits? If there is not a network provider in my area, what are my options?
  • Do I need a prescription? Do I need preauthorization?

 

How can Bosom Buddies help?

Bosom Buddies will bill any insurance carrier for breastfeeding equipment (pumps, spare parts, and some other supplies) as well as lactation classes and services if arranged ahead of time and after verifying benefits. We will be considered an out of network provider, with the exception of the following, for which we are an in-network provider:

  • Aetna, for lactation classes and consultations with Robin Williams, IBCLC
  • CHP+ Colorado Access, for breast pump rentals, some parts and supplies, and lactation consultations, all with pre-approval.

 

We do accept Cover Colorado for breast pump rentals and lactaton consultations (coverage may vary and copays and/or coinsurance may apply)

We have also had a few customers successfully request a waiver with Anthem Blue Cross to consider us a network provider. Talk to Anthem about how to submit for reimbursement, requesting they cover as an in-network service.

Health insurance is a contract between you and your insurance company. While we do the best we can to provide accurate information and help with claims, ultimately the contract is between you and your insurer.

If you would like to discuss billing your insurance company for breastfeeding supplies or services, please verify with your insurance company your benefits, including out of network benefits unless with Aetna or CHP+ Colorado Access. Then email us your findings as well as what products or services you want, when you need them, and copies of your insurance card and driver’s license. We will have one of our insurance specialists contact you, generally within 2-3 business days.

We are still learning! If you have any information you have learned from your experiences in working with your insurance company, please let us know.

*http://www.hhs.gov/healthcare/facts/factsheets/2010/07/preventive-services-list.html#CoveredPreventiveServicesforWomenIncludingPregnantWomen