Hi Moms, I read in some websites that breastpumps are covered under durable medical equipment by Blue Cross of California Insurance. I have the EPO plan. I called the insurance company and they told me its covered. But I would like to confirm if someone has "actually purchased" a breastpump and got it covered?
If so, what is the procedure?
Which plan did you have in BlueCross? EPO/PPO/HMO?
Whom should I get a prescription from?
How should I get the insurance company to pay for it?
Please provide as many details as possible. Thanks!
Thanks everyone. So here's what happened :
- The insurance company said it would cover if I got a letter from my doctor as a medical necessity.
- I need to get the pump from a DME supplier who deals with the insurance company.
I cannot find a DME supplier that already holds breastpumps. I haven't tried asking them to get me one. The couple of places that I spoke to said that usually the insurance companies agree to pay for the pump but when the letter is submitted, they reject the request.
I will update if I have more information. I live in San Jose, California.
I'm not sure how Blue Cross Works but I got a breast pump covered through my insurance(medi-cal) The lactation consultant at the hospital did all the paper work and billing for me. I just stopped by her office and picked up the pump. So I would call your local hospital birthing center and ask for the lactation consultant and ask her the procedure with your insurance
Check with your insurance benefit dept. As far as I know most insurances do not cover breast pumps unless your baby is medically disabled . The only person I know who got one covered (a very nice hospital grade one that a consumer cannot purchase themselves) had a baby born with a syndrome that produced a severe cleft palate (no roof to her mouth), severe gastric issues and severe retardation. To this day eight years later she is still fed thru a tube with a port to her stomach (obviously even with cleft palate surgery she cannot use a bottle or eat with her hands and mouth), although they did find (after 5 years) a specialized formula she can tolerate instead of breast milk (which the insurance pays for too as it cannot be bought in regular stores).........The only way to know is to call your insurance and ask if there are ever any circumstances in which one is paid for and then determine if you meet that set of circumstances. I would recommend if you buy your own, to buy the best you can afford because they are worth it.
I thought the same thing and was told that it was covered after speaking with someone from Blue Cross who put me on hold to review my policy. As it turned out, when I completed all the information (prescription from OBGYN, receipt and filled out the forms) was notified that it would not be covered. You could get a prescription and at least try to get reimbursed. Good luck!
Contact your insurance company directly and make sure it is a covered expense. They will be able to give you information on the procedures you need in order to have it covered. Unfortunately most insurance companies have different coverages for different companies they insure so your coverage under the same type of plan could be totally different than someone else's coverage.
I know that under my insurance they only covered a breast pump if the baby was in patient at the hospital (away from mom and unable to be nursed). In my case the hospital loaned me a pump so it didn't cost anything.
Contact your insurance company and talk to an actual person to get an answer. I have BC PPO in another state, had a baby 7 weeks early, got a Rx from the doctor in the NICU and they still would not even cover the rent of a breast pump. I was pretty furious but got over it and bought a cheap breast pump that I hated. Next time I will upgrade and buy the nicer one.
I thought this was the case when I was pregnant with my 2nd child it turned out that it would only of been covered if baby was born prematurely and was in the hospital per DRs orders and needed a script for it in order to get an electric breastpump because then it would be a durable medical equipment does that make sense.
Why can't you call the insurance back and ask them the correct procedure & process this would only not give you coreect and acurate information but gives you the chance to ask more questions and hopefully get a correct answer
Updated
I thought this was the case when I was pregnant with my 2nd child it turned out that it would only of been covered if baby was born prematurely and was in the hospital per DRs orders and needed a script for it in order to get an electric breastpump because then it would be a durable medical equipment does that make sense.
Why can't you call the insurance back and ask them the correct procedure & process this would only not give you coreect and acurate information but gives you the chance to ask more questions and hopefully get a correct answer
