The Affordable Care Act (or ACA or Obamacare) has received a lot of attention for a lot of different reasons, but there’s one piece of the legislation that I am really excited about: Health insurance plans are now required to cover the cost of breastfeeding support and equipment for nursing moms, including the cost of lactation counselors and breast pumps.
Because the law is so new, a lot of expecting moms don’t know yet that they may be able to get a breast pump for free. And, unfortunately, a lot of insurance companies are still figuring out exactly how they’re going to interpret “breastfeeding support and equipment.” What this means is that you need to call your insurance provider to find out exactly what is covered under your unique plan.
From pregnancy all the way through giving birth and the post-natal period, it’s important to have a list of questions ready for your healthcare provider and/or insurance provider. Questions like: “can I rent or buy the pump?” and “do I need to get a prescription? And if so, from whom?” are important to ask, so you can maximize your benefits and get the best breast pump your insurance offers. Here are sample lists of great questions to ask in different scenarios.
Questions You May Need to Ask When You’re Expecting
- Can I rent or buy my breast pump?
- Is there a maximum amount you will cover?
- Do I have to get a specific type of pump (manual versus electric)?
- Do I have to get a specific brand of pump?
- Do I need a prescription to get the breast pump? If so, from who (pediatrician versus OB-GYN)?
- Can I get the breast pump before my baby is born?
- Can I buy my pump at a retail store (like Target or Babies ‘R’ Us) and be reimbursed?
- Do I have to go through a specific provider to get the pump?
- I want a different pump than the one offered through this plan. If I want to upgrade to a different pump, can I pay the difference out-of-pocket?
- This plan covers manual pumps but I know I will need an electric pump. If I want to upgrade to a different pump, like the Lansinoh Signature Pro Healthcare Double Electric Breast Pump, can I pay the difference out-of-pocket?
- Do you cover additional breastfeeding supplies, such as nursing pads, bottles, or HPA Lanolin? If so, do I need a prescription? Can I buy them at a retail store and submit receipts for reimbursement?
Questions to Ask When You’re Trying to Get Your Pump
- The pump I want isn’t covered by this plan. If I want to upgrade to a different pump, like the Lansinoh Signature Pro Healthcare Double Electric Breast Pump, can I pay the difference out-of-pocket?
- The provider you sent me to buy my pump from is out-of-stock but I need a pump now. Can I buy my pump at a retail store (like Target or Babies ‘R’ Us) and be reimbursed? If not, what do you recommend I do?
- Do I need a prescription to get the breast pump? If so, from who (pediatrician, OB-GYN, nurse practitioner)?
Questions to Ask About Breastfeeding Support/If You Need to See a Lactation Counselor
- Do I need a prescription for a lactation counselor visit?
- Do my visits need to be pre-authorized?
- Is there a maximum number of visits covered?
- Is there a maximum dollar amount covered by visit?
- Are there limitations to which lactation counselor I see?
- What if the lactation counselor I want to see is out-of-network?
- If I see someone out-of-network, can I pay the difference out-of-pocket?
It is really exciting to see our legislators recognize how important breastfeeding is to a mother and her child’s health, and to require health insurance companies to support breastfeeding moms. The law isn’t perfect, but it’s definitely a step in the right direction!
Gina Ciagne is a Certified Lactation Counselor and La Leche League International-trained breastfeeding peer counselor. She is the Vice President of Healthcare at Lansinoh
