Return to: Choosing a Breast Pump
Is My Breast Pump Covered By My Health Insurance Policy?
In 2012 with the passage of the Affordable Care Act made all breast pumps E0603 a covered item for most insurance plans. Finding your free breast pump can be a bit challenging depending on where you live and which insurance company you have. The best places to find an insurance covered breast pump would be through a national DME provider like a Medline. Having a quality breast pump can often be a determining factor in how long a mother is able to provide her child with breastmilk.
If you hope to have your insurance company help with the cost of your breast pump, there are a few guidelines that you should adhere to when selecting and purchasing a pump. Prior to buying a pump, you should:
- Familiarize yourself with your health insurance policy. Read through your policy to see if your coverage will cover the total or partial cost of a breast pump. Discuss your options with an agent from the company.
- Determine whether you will need to qualify in order for the coverage to apply. Some health insurance companies require that a pump be deemed medically necessary (defined below) to qualify for coverage. You may also need to receive prior authorization before making your purchase.
- Know what your policy will cover. Does your coverage apply to purchase pumps, rental pumps or both? Are your choices limited to a specific brand or type of pump? Is there a time limit on rentals? What is the maximum dollar amount that will be covered?
- Find out if there are any other stipulations to the coverage. Will you have to meet your deductible before the coverage kicks in? Will there be a copay?
What qualifies a breast pump as medically necessary?
A breast pump is considered medically necessary if your baby is premature, sick, having difficulties nursing properly, or is intolerant to artificial baby milk. Your doctor may also deem a pump medically necessary if you are experiencing medical problems that prohibit you from breastfeeding, will be nursing twins or other multiples, will be physically separated from your child for long periods of time or plan to work outside the home. Also, to determine if you have flat or inverted nipples and will need to begin working with your breast before your baby is born see our article Do I Have Flat or Inverted Nipples? In certain cases when breastfeeding could be compromised based on retracting nipples, insurance could help you to attain a pump to prepare for breastfeeding.
When explaining why your breast pump is medically necessary, your doctor will use an ICD-9 Code to communicate your diagnosis to your health insurance company.
|Breastfeeding Related ICD-9 Codes|
|Abnormal tongue position||750.1|
|Neonatal candida infection||771.7|
|Other transitory neonatal||775.5|
|Feeding problems in newborn||779.3|
|Abnormal loss of weight||783.2|
|Feeding difficulty – infant||783.3|
|Failure to thrive||784.4|
|Suck reflex abnormal||796.1|
|Twin pregnancy post-partum condition or complication||651.04|
|Abscess of nipple||675.03|
|Infections of nipple||675.04|
|Abscess of breast||675.1|
|Other specified infection of breast and nipple||675.8|
|Unspecified infection of the breast and nipple||675.9|
|Engorgement of breasts||676.2|
|Other and unspecified disorder of breast||676.3|
|Other disorders of lactation||676.8|
|Unspecified disorder of lactation||676.9|
When you are ready to file your claim, be sure to follow all of the guidelines and stipulations that your insurance company has provided. Remember to file your claim promptly after your purchase because insurance companies generally require that all claims be filed within a one year time frame from the date of service. Filing after the set time limit could result in your claim be denied without consideration.
If you need help finding the right breast pump for your pumping needs, compare different pump models side-by-side on our Breast Pump Comparisons page and read customer submitted reviews on our Breast Pump Reviews page.
Return to: Choosing a Breast Pump