Breast Pumps Under the Affordable Care Act

Breast pump on table.
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The Affordable Care Act (sometimes referred to by its nickname: Obamacare) offers new mothers the chance to save money on breastfeeding supplies and lactation consulting. The ACA mandates that insurance companies cover the cost of breast pumps and lactation consulting. However, the language used in the provision is vague and perhaps even confusing. According to the HRSA website, the provision states that the Affordable Care Act covers the following:

“Comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum period, and costs for renting breastfeeding equipment… in conjunction with each birth.”

Notice that the provision does not state what kind of pumps, what kind of lactation professionals or how mothers get their care. Here are some tips to help you navigate the system.

Call Early, Call Often

If at all possible, call your insurance company when you are pregnant. You may need to talk to more than one person to find the correct answers to your questions. Because the mandates are new, not all insurance representatives know about the breastfeeding supplies and assistance information. Find out if your plan was grandfathered out of the clause. Ask your insurance company about what kind of pumps your policy covers and by what method you receive your pump. Some policies cover only manual pumps, some policies cover the cost of rental and some will provide double electric breast pumps to new mothers. Be sure to also ask what type of lactation professionals your insurance covers. Some plans only cover lactation help if a medical doctor provides it, while others cover lactation counselors and International Board Certified Lactation Consultants (IBCLC). Ask if there is a cap on the number of lactation visits or amount billed. If you do not like the answers you are receiving or if you feel like you are getting information in error, continue to ask to speak with someone else at your insurance company who can help you.

Start Your Breast Pump Research

If your insurance company tells you that they only cover manual pumps, find out if you can get a double electric pump if you have a doctor’s written order. If they tell you that you are eligible for a variety of pumps, you should investigate which type of breast pump you want to use. Be aware that when this provision came into effect, many new breast pump companies came onto the market. Manufacturers know where there is money to be made! Not all pumps are created equal, so be sure to find a pump with a quality motor (if it is electric) that meets your needs. A lactation consultant can help you navigate the many breast pump options available to you.

Find a Lactation Care Provider

First, you’ll want to determine what kind of lactation professional you need. There are many levels of lactation professionals from which to choose. Make contact with your chosen breastfeeding support person to ask her if she accepts insurance. If not, ask her if she will give you a superbill or a receipt to submit to insurance. Some lactation consultants bill insurance while others provide you with the information to seek reimbursement.

Contact the Breast Pump Disbursement Company

Some larger insurance companies will send you a breast pump directly. Other, smaller insurance companies may provide you with a list of medical supply companies from which you can get your breast pump. You’ll want to call those companies to make sure that they stock the kind of breast pump that you want and the expected wait time to receive a pump.

Do as Much as You Can Before the Baby Comes

Pregnancy to-do lists can be overwhelming. However, I’d say that the importance of breastfeeding puts this task above the importance of finishing the baby’s nursery. Your baby won’t notice if the cute curtains are up but she will appreciate you doing everything you can to get your breastfeeding relationship started off right. Don’t think that you’ll do all of this when the baby comes – you want to be able to access a lactation professional as soon as you need it. You’ll also want to be able to speak to your insurance company without a crying baby in the background. If your pump takes a few weeks to ship, it’ll be nice to know that it has arrived before the baby. You can then familiarize yourself with its features before you need it.

If You’ve Had a Baby Recently, Call Anyway

Even if you think you’ve missed your window of opportunity, call your insurance company. You may find that your insurance company has a longer policy for when you can receive your breast pump or lactation care. It never hurts to ask.

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