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Insurance and Breast Pumps


Forum: September 2013 Playroom

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  #1  
June 24th, 2013, 01:56 PM
CARLACB's Avatar Mega Super Mommy
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Okay, so I just called my insurance company to find out more information about if breast pumps were covered, how long, rental, etc. The representative told me that I get a choice between a manual or a electric pump and everything is covered the tubes, bags, breast cups?, etc. I just had to provide the medical supply company with my insurance info and doctors info. They can provide me with the pump up to 30 days prior to the baby's due date!!! This has made my bad day turn into a FABULOUS DAY. I get a choice between the

Ameda Purely Yours® Electric Breast Pump
Medela Advanced Personal Double Breast Pump
Playtex® Double Electric Breast Pump


Which one is better? I was thinking about the Medela? Have you ladies contacted your insurance companies yet? If not, CALL!!!!! This could be saving you ladies 200+ bucks. Heck if insurance is covering it...I'll take it and I don't need to have a prior medical condition or anything like that. I have Anthem.
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  #2  
June 24th, 2013, 07:08 PM
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I was going to post about this. I got a ton of info from a friend of mine from my old DDC who is the queen of pumping!! Pick the Medela hands down. Put in your order as early as they allow you to and tell them not to send one unless they have the medela in stock. Those go very fast a lots of times women end up getting a different one even if they had ordered the medela. My insurance co gave me three vendors to call. But my policy will also cover an electric double pump at 100% if purchased at any in-network Durable medical supplies dealer. I have started calling them all to find out if anyone carries the Medela Pump In Style Advanced, which is the one I want. The medelapersonal double electric one is the same motor as the PISA but sometimes it may not have the let down button option and the bag is not as fancy I will settle for that if I dont score a PISA, but I want to try. Also a coworker gave me her 12 yr old Medela Pump instyle original which she never used more than a few times as she switched her baby to formula due to supply issues at 1 month or so - and I am paying her $50 for it. Will be ordering new tubing etc. This way I can have one at home and one at work and not lug the whole thing back and forth!!
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  #3  
June 24th, 2013, 07:18 PM
CARLACB's Avatar Mega Super Mommy
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Funny you say that about the ordering of the Medela because right now there is a 2 week delay on them. The other 2 pumps are in stock and ready to ship lol I can place my order since I don't need prior authorization and the company will contact my doctor and all that good stuff. I don't know if my insurances medical supply company is on your list but it is Edgepark Surgical (edgepark.com).

Wic was going to give me one after 3 months of using the manual but they don't replace tubing, give me nursing pads, etc so I'll go with my insurance company.
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  #4  
June 24th, 2013, 07:58 PM
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Yep Edgepark is one of the vendors they had me call. The other two were Byram & Genedyne ..Two of them have medela the other one doesn't but they have another brand that I've never heard of, however its hospital grade. If you are eligible, I say get the wic one too...pumps are so expensive and if they break for some reason and you cant replace it in time you'll be stuck. Its always good to have a spare if you can afford it or get it for free especially if you are a working mom!
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  #5  
June 25th, 2013, 06:23 AM
Keakie's Avatar Learning to walk in faith
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As someone who's new to the US healthcare stuff and who's regularly overwhelmed and confused by the whole thing, how would I start contacting our provider about it? We're with Aetna, if that matters. It would be really nice to be able to get something like a Medela without paying several hundred dollars.
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  #6  
June 25th, 2013, 07:03 AM
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Kayla, we have united and I don't have much insight on Aetna. However, there is this new legislation that requires insurance companies to provide "some" coverage for breast pumps. (this wasn't there a few yrs ago when I had Lekha) . Hence this stuff is pretty new even for BTDT moms. You will just need to call your insurance provider's customer support number and ask them what is their policy with regard to breast pump coverage. They will usually direct you to a few of their preferred vendors who will then help you out with what they offer and how soon you can order one. Some insurances suck and they only cover manual pumps, but many of them cover double electric ones including Medela personal double electric(this model is not commercially available and is only available through insurance covered durable medical supply dealers) - It is essentially the same motor as the pump in style advanced with some minor feature variations. Some insurances will not let you order until your last trimester or even until you give birth. Some may require a prescription from your caregiver. The rules vary. That's why its best to start making the calls now! Good luck!
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  #7  
June 25th, 2013, 07:13 AM
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Yes I have a DME and we rent and sell pumps. If you have any insurance questions feel free to ask me. One word of advice, if you don't like what your insurance company tells you, keep asking questions and tell them why it's important to have one pump over the other etc...We have gotten insurance companies to cover double electric pumps for clients over the manual pump because we wrote letters and stated the importance of using a double electric pump for moms who return to work. If they deny it, please keep fighting. The Medela double electric pumps are open pump systems so you cannot sell them when you are done. Check out Hygeia brand pumps, they are comparable to Medela and are closed pump systems so you can resell them once you are done and get some money back.
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  #8  
June 25th, 2013, 07:19 AM
Keakie's Avatar Learning to walk in faith
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Thanks so much, Anitha!
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  #9  
June 25th, 2013, 07:47 AM
Alpha_allie1010's Avatar Platinum Supermommy
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Mine only covers a manual pump unless you are returning to work or have a baby in the NICU then you get a double electric .
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  #10  
June 25th, 2013, 07:51 AM
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Quote:
Originally Posted by juleeannk View Post
Yes I have a DME and we rent and sell pumps. If you have any insurance questions feel free to ask me. One word of advice, if you don't like what your insurance company tells you, keep asking questions and tell them why it's important to have one pump over the other etc...We have gotten insurance companies to cover double electric pumps for clients over the manual pump because we wrote letters and stated the importance of using a double electric pump for moms who return to work. If they deny it, please keep fighting. The Medela double electric pumps are open pump systems so you cannot sell them when you are done. Check out Hygeia brand pumps, they are comparable to Medela and are closed pump systems so you can resell them once you are done and get some money back.
I understand that the Medela is not a closed pump system, but the resale market is so huge despite that fact. Plus its been so widely used, tried and tested and so many woman swear by it. These are the reasons I am leaning strongly toward the medela. I would like to be educated on some things though, please do let me know if you have some insight on this.

The claim is that medela is not a closed system and some milk can sometimes enter the tubes and eventually the motor itself and if used my more than one user, cross contamination can occur. Plus mold etc. can grow and can never be completely sterilized. I believe that true cross contamination can occur only if the pump is used by two or more users during the same period. Example I use it today and let my friend use it tomorrow and she returns it back to me the day after etc. But with regards to the mold issue, if that can really happen so easily, then what prevents the mold from contaminating the milk even with the single user?? I am not convinced that its hazardous to use a 'used pump' as long as the tubing, shells, bottles, valves and everything is replaced. The face plate of the motor can be removed and wiped down with disinfectant wipe.

Do you have any inside info on this?

Also what are your thoughts about this pump? Have you heard of this one? I can't find any user reviews or any info at all about this on the internet apart from what the manufacturer has put out there: https://www.lucinacare.com/insurance_orders.html

Also how does the hygeia compare to the medela in terms of suction..and helping with increasing the supply etc?
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  #11  
June 25th, 2013, 08:51 AM
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I understand, I bought a used Medela pump with my first child too but after going through my training, I would never ever do that again. I learned so much and I do have access to the research if you would like me to send it to you. It was very interesting. The mold and bacteria was found many months to years later because a lot of moms will store their pump in the closet for their next baby. In most babies it might not be a problem but babies with a weak immune system or preemie babies might have a harder time with the mold and bacteria. Just something to consider. The CDC is starting to crack down on the resale of closed pump systems and some of the Medela pumps no longer have the option to remove the face plate.

Hygeia pumps have just as much suction if not more than the Medela pumps. I have used both and I do like Hygeia better. With my clients, I would say 80% prefer Hygeia over Medela.

Lucina pump: I have not heard of the pump, but it reminds me of the Spectra Baby pump and I have heard good things about that pump too and we hope to be carrying the Spectra Baby in the near future. I can ask fellow lactation consultants to see if they have heard of Lucina and let you know.
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  #12  
June 25th, 2013, 09:08 AM
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Thank you, juleeannk! Yes please send me more material if you have access to it. I will PM you my email ID. If its just links, you can just PM me. Thank you. Hygeia sounds very promising...off to do some more research. I know of the bat that United does not offer it...but there might be a way to get them to cover it. BUT I'll first research the pump a little more before I get into that.
Yes let me know if you find out more abt the Lucina too!! Thanks again so much for all this info!

Thank you, juleeannk! Yes please send me more material if you have access to it. I will PM you my email ID. If its just links, you can just PM me. Thank you. Hygeia sounds very promising...off to do some more research. I know of the bat that United does not offer it...but there might be a way to get them to cover it. BUT I'll first research the pump a little more before I get into that.
Yes let me know if you find out more abt the Lucina too!! Thanks again so much for all this info!
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  #13  
June 25th, 2013, 11:53 AM
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I am getting one thru cigna. I already called and they told me to call back 30 days before I deliver (since I am being induced).

I am going to have my doctor send over a note asking for a hospital grade rental (symphony) since I am planning on returning to work and I had supply issues in the past. I hope they approve it!
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  #14  
June 25th, 2013, 12:02 PM
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Mindy, is the hospital grade one portable? Will you be able to take it back and from from home and work?
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  #15  
June 25th, 2013, 12:08 PM
CARLACB's Avatar Mega Super Mommy
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You ladies have been sharing a wealth of information with each other, so glad that I started this thread. I know that the new law doesn't affect Tricare or grandfathered plans if I am not mistaken. Even if you think your insurance won't cover your own personal pump or a rental. Try to get in contact with your local WIC office, La Leche League coordinator and I know some hospitals will give you a pump (if you explain your situation). Start making those calls now ladies!!
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  #16  
June 25th, 2013, 01:12 PM
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Tricare will cover a hospital grade rental if there is medical need and if the hospital rents it to the mom. We are trying to change that because not all hospitals rent pumps to mothers outside of the hospital.
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  #17  
June 26th, 2013, 07:28 AM
manda622's Avatar First Time Mommy-To-Be
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I called my BlueCross a few months ago to check on this and they told me I would be covered 80% for a double electric, couldn't order until after the baby, and needed a doctor prescription. But, when I looked online at my benefits the other day it says online they're covered 100% so I'm wondering if the person I spoke to was using old information? I'm going to give them another call tomorrow, to see if it's 100% covered and if maybe I can order it before then. Either way, I'll take it- 80% and after baby comes is better than nothing! The only supplier sort of near us that has the Medela offers free UPS shipping, so I figure as long as it's in stock it should be waiting for us when we get home from the hospital...
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  #18  
June 26th, 2013, 09:36 AM
Veteran
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Kayla, here's some info I got from my insurance. I have Aetna also.

Quote:
This is in response to your e-mail inquiry dated 06/25/2013 regarding
your coverage for a dual electric breast pump.

I appreciate you taking the time to contact us, Kelly. Your plan allows
a standard electric breast pump only once every 36 months. If you use
an in-network provider, it will be covered at 100% of the contracted
rate with no member cost share. If you use an out-of-network provider,
it will be covered at 70% of the allowed charges after your $10,000.00
calendar year deductible.

If you have additional questions, send us a 'Contact Us' message or call
the toll-free number on your member ID card, if applicable.
If you happen to live in Middle TN, I can give you the list of local providers they sent me, also.

Hope that helps!
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  #19  
June 26th, 2013, 09:55 AM
WorkerBeeMama's Avatar Mega Super Mommy
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Anitha - It is portable. It is not as easy as the other ones, but all you have to do is throw it in a large tote/bag and you're ready to go.

I had a rental with my first and I bought one with my second (medela backpack double electric type). I think the rental worked better for me. The symphony is supposed to be the best, so I am hoping I can rent that one.
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  #20  
June 26th, 2013, 11:49 AM
kelbert's Avatar a.k.a. Kelli
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I am glad this thread was started too! I just checked our insurance and we have 100% coverage, just have to call the providers and see what I can get. I hate talking on the phone ><
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