Breastpumps, Lactation Services and Coverage

Mom with baby 2On Wednesday, Duke Regional provided a few basics about the Affordable Care Act. Here is something you might not know: the Affordable Care Act requires health plans (this does not include Medicaid or WIC) to cover breastfeeding support and supplies. And, many health plans have already begun implementing this coverage.

Surveys conducted with some of the largest insurance companies have provided valuable insights into the implementation of benefits and coverage criteria for breast pumps and lactation counseling. Here is what was learned:

Your voice can be heard. Insurance companies are still shaping their breast pump coverage policies. Don’t be afraid to speak up for what you want – it just might make a difference, for you and for many other breastfeeding moms.

You don’t have to worry. If you or your baby has a medical issue, like the need to initiate milk supply or if your baby is in the NICU, chances are you’ll get the hospital-grade pump you need. Seventy-seven percent of insurance companies surveyed cover them – but most require pre-authorization, so be prepared and ask for a prescription.

You have time to educate yourself. The majority of plans don’t allow pump pickup until your baby’s delivery or after. But you’ll benefit by being proactive. It’s never too early to ask your insurance company what pump they offer and when you can get it. Research pumps beforehand. This way, you’ll already know what you want when the exciting time comes!

You don’t have to compromise. Sixty percent of plans surveyed allow you to upgrade from their basic option to the pump of your choice – you just pay the difference. Not all plans will proactively communicate this to their members.

You don’t have to go without. Most plans require you to get your pump from an in-network provider. But, 76 percent of plans surveyed are also flexible if the covered pump isn’t available, letting you choose another pump or even reimbursing your purchase from a retail store.

You don’t have to go it alone. Nearly all plans cover lactation counseling without a co-pay.

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