Comments on: Insurance Reimbursement of Breast Pumps – Sample Letter

By: MTH81

MTH81 — Mon, 29 Apr 2013 20:46:00 +0000

Even with the new requirements under ACHA aka Obamacare, BCBS FL would not cover electric breastpump, and stated that it is considered a convenience item unless mother and baby is separated (extended hospitalization), medical conditions prevention latching, etc. BCBS FL’s representative stated that they meet all guidelines of ACHA by providing a manual pump to lactating mothers.

By: Wendy

Wendy — Tue, 09 Oct 2012 01:05:00 +0000

In reply to Anapd.

What the insurance company will cover and what you can deduct as a medical expense (in excess of the AGI floor) on your tax return (or what you can use your flex spending account to pay for) are really two different things. My insurance company also will not cover breast pumps that are not considered “medically necessary”, but because of the change to the federal law, I can include the breast pump in my medical expenses for the year, of which the amount over my AGI floor is deductible (note that no tax advice is intended here….) In my opinion, the intent of the letter above is meant to convince the insurance company that the pump should be considered medically necessary (the author is providing diagnosis codes as support) and should thus be covered.

I am not sure what the purpose of the links to the IRS publications is, other than to suggest that since they are accepted as medical expenses by the IRS they should also be covered by insurance. I certainly agree with that thought though!

By: Ladybug

Ladybug — Wed, 19 Sep 2012 20:26:00 +0000

When my baby is born, she will be under one health care plan (Blue Shield of California) while I will be on another (Anthem Blue Cross of California) due to COBRA. Who do I ask if they will reimburse, my insurance or the baby’s insurance?

By: Jill

Jill — Wed, 23 May 2012 16:45:00 +0000

Our insurance co covered any pump that I wanted as long as it was purchased from one of their approved medical supply companies (no medical need necessary). So I chose the best – a hospital grade Medela just like I used in the hospital. What they failed to mention was that after the end of the yr, I’d have to pay my deductible & monthly copays for another yr. Ended up paying about $350 out of pocket for it but it is valued at over $1200 (or over $5000 if you ask the medical supply co that I had to use).

My biggest advice if you go this route is NOT to get one from Apria. They messed this up royally which is why I ended up paying so much out of pocket. They actually owe me about $150 but I’ll probably never see a penny of it.

By: Jessica M Norman

Jessica M Norman — Tue, 01 May 2012 08:43:00 +0000

In reply to B3autiful3y3z.

Not sure if this reader already knew this but I do notice a lot of people that say flexible spending accounts pay for this…. An some of those people dont realize that in reality they are still paying for it. Just through their paycheck with a slight tax advantage. It has surprised me how many people think if their flex pays it they are getting it free…

By: Mwaterbury

Mwaterbury — Sun, 15 Apr 2012 21:28:00 +0000

In reply to Anapd. Your company will only cover a pump if u need to pump because there is some type of illness that makes it so the baby can't directly latch on to the breast.

By: B3autiful3y3z

B3autiful3y3z — Fri, 30 Mar 2012 02:19:00 +0000

Insurance companies may only cover it if it is medically necessary but if you have a Flexible Spending Account they will pay for it

By: Anapd

Anapd — Thu, 29 Mar 2012 16:04:00 +0000

I just emailed my insurance company regarding this. It seems they only cover if it’s medically required, which doesn’t align with the info above. Can someone decipher this?

[Insurance company] only covers a breast pump as medically necessary when either of the following criteria is met:

The infant and mother are separated due to hospitalization, and direct breastfeeding is not possible.
The infant has a medical condition or congenital anomaly that prevents effective breastfeeding.

By: Bdaltonibclc

Bdaltonibclc — Wed, 21 Mar 2012 17:00:00 +0000

Did this mother get payment for her pump?