Breastfeeding, The ACA & You – What I Have Learned This Month

This past January, after learning about new provisions in the Affordable Care Act that provides new mothers with breast pumps and lactation services, I wrote a post about my experiences calling my insurance. You can read that post HERE. The provisions were very unclear and there does not seem to be any consistency at all about how that portion of the law is being interpreted.

Fast forward 6 months. My little guy has arrived and I am now in need of both lactation services and a new breast pump. Our state insurance started its new plan on July 1st, so I am optimistic that our plan is going to cover some (if not all of the services under the new provision). Fingers crossed, I make the first call.

Call #1:

Me: Hi, I am calling to find out my benefits for lactation services and breast pumps.

Rep: Yes, hold on one minute and let me look that up. [silence] Yes, your plan covers both services at 100% as long as you use an in-network provider. Out of network you will pay a $400 deductible for a breast pump.

Me: Wonderful, do you know where I am able to order a breast pump? Do I need a prescription?

Rep: I do not know about needing a prescription but I do have a list of durable medical providers that you are in-network. [gives me companies, names, etc]

Me: Great, Thanks. 

Take a little break, do a little online research and then call the 3 durable medical companies I was provided.

Here are the three durable medical companies that I was provided. I am including them here because I believe that it will aid you in your own research but by no means is this a recommendation nor endorsement. I actually found most of the representatives to be less than friendly and very pushy to order from them even though they were not able to answer even my most basic questions about the equipment.

• Genadyne/Lucina
• Edge Park
• Byram Health Care

Of all three companies, none of them seem to offer a high quality medical grade breast pump that is familiar to me. Most don’t come with supplies or even a carrying bag. I was feeling discouraged and called my lactation consultant to ask her about the brand names I had been given. She too had never heard about any of these companies and said she could not recommend any of them.

Back to the drawing board and online research.

Since I have used a breast pump before, I was determined that I wanted to have a Medela, Pump In Style. I decided to check the Medela site and sure enough there is an entire section answering questions regarding insurance and list of known providers for their equipment. Clicking on the link, I found out that our local Children’s Hospital has a home care division that provides breast pumps. I called the number listed and was connected to their onsite lactation consultant.

Right from the start, Katrina was fabulous. She was extremely knowledgeable and helpful. She gave me some pointers to calling my insurance and let me know that they are considered in-network for my insurance. Armed with my knew knowledge, I called again.

Call #2:

Me: Hi I called yesterday but I want to confirm some information regarding my benefits for breast pumps.

Rep: Yes, how can I help you?

Me: I have found an in-network provider that is local. Can you confirm that my insurance covers a “Double Electric Breast Pump.”

Rep: [reading from the benefit sheet] You are covered at 100% for a hospital grade breast pump.

Me: Do you know what that means? Because the companies that I was originally provided are not offering a “hospital grade pump.” Do you mean a rental?

Rep: No, it just says, hospital grade.

So, I called back to the local representative and she took the time to call my insurance and clarify for me and does confirm that I can receive the Medela pump that I prefer and it is covered at 100%.

At this point I have invested several hours into research, phone calls and time but I am very pleased with the outcome. Having a knowledgeable advocate was very helpful. Here are some things that she told me:

• Because of the ACA, many medical companies are jumping into the breast pump manufacturing business. So, you will start to see many new brands on the market. Most of which do not have the quality and testing that other companies might have.
• Each durable medical company will have contracts with DIFFERENT brands. So don’t assume that if you call one company that their pump(s) are the only ones that your insurance provides.
• If you have a brand of pump that you really want, call them and ask them for providers in your area.

Here are some things that have not changed since my last post:

• Each insurance/policy is interpreting the ACA differently so some people are getting a free hand pump in the hospital, where others are only getting rental services. *Be careful accepting supplies/pumps in the hospital. They will bill your insurance and you may find that they count this as your “one pump per birth” benefit.
• You will probably need a prescription from your care provider.
• You are not able to get the pump before you have the baby. So doing your research and being prepared before hand will really help you if you need a pump in that first few days. You won’t be making a regretful decision.
• You can’t just buy a pump in the store and expect to be reimbursed.
• Many individuals still do not have coverage due to a “grandfather” clause in their policies. If this is the case for you, I have read that you can try to fight and file a reconsideration.

The moral of the story is that the ACA Breastpump and Lactation provision is still very unclear. Taking time to really educate yourself and if possible finding an advocate or local provider will prove to be very helpful. I picked up my Medela Pump In Style yesterday and am very pleased with the support I received from our local provider.

This is just my own personal experience but I hope this information is helpful. I know it doesn’t answer all your questions but maybe gives you some pointers to aid in your quest to access your benefits.

*This piece is not sponsored in any way but I did include the link to Medela because I think that the information they are providing is extremely valuable.