Navigating insurance coverage
Dr. Jones
Pediatrician
To get the lowdown on breast pump and lactation support, ask your provider the following questions. Willow also provides an insurance estimator and insurance coverage tool.
New health insurance plans in the United States must provide coverage for breastfeeding support, counseling, and equipment for the duration of breastfeeding (sometimes starting when you’re pregnant), according to Healthcare.gov. If yours is an older, grandfathered-in plan that doesn’t advertise any such coverage, you can still ask some of the following questions to determine whether you’re able to receive any benefits.
If you have an exact make and model in mind, ask about it. If you only know the make, or you have a few options you’re still considering, get as many details as you can about the models your insurance covers. You can also ask whether your provider covers multiple pumps, in case you want to use more than one pump to support different needs and situations.
Some insurers cover up to a certain dollar amount, leaving you to pay the balance. For example, if your provider covers up to $300 for a breast pump, but your pump costs $500, you might owe $200. Or your provider may require you to pay a deductible, then cover all or some percentage of the rest. Ask an insurance company representative to be as specific as possible—and to email you the details so that you have the policy in writing.
Some providers allow you to order your pump as soon as you know that you’re pregnant. Others may make you wait until 30 days before your due date. If it’s 30 days prior, set a calendar notification to place your order then so you don’t have to deal with pump insurance coverage as you care for your newborn.
If you’ve already purchased a pump, your plan may be set up to reimburse you. Keep those receipts, and call your provider to ask.
To pump, you’ll need flanges, tubes, bottles, and other storage supplies that may or may not come with your pump. Your provider may not separately cover them. If it does, find out which parts from which brands it covers—and up to which dollar amount. And if your regular plan doesn’t cover these parts, look into buying them through a separate health care savings account.
Your insurer may allow you to purchase the pump of your choice and then reimburse you. Alternatively, your insurer may work with a durable medical equipment (DME) company from which you’ll need to order your pump for complete coverage. Get the coverage requirement details.
Your insurance provider may require you to have a prescription from your doctor or otherwise show proof that you’re receiving maternity care. When insurance providers require a prescription for lactation equipment or counseling, they typically ask to see the physician’s national provider identifier (NPI) number and a diagnosis code (for pregnancy). Ask your physician or midwife for additional assistance.
The Affordable Care Act mandates that insurance providers cover lactation support. Most plans cover six to eight appointments with a lactation consultant, starting during pregnancy and extending throughout the duration of breastfeeding. If you’re able to, start the process while you’re still pregnant (SimpliFed keeps it easy with virtual care) so that you can get help on anything from making a breastfeeding plan and establishing breastfeeding to returning to work and weaning.
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