If I Switch Insurance Can I Get Another Breast Pump?
Switching insurance? Discover if your new health plan covers another breast pump and how to navigate the process for obtaining it.
Understanding health insurance coverage for breast pumps is a common consideration for new parents. A breast pump can significantly support an infant’s feeding journey and a parent’s ability to provide breast milk. This article explains breast pump coverage and how changing health insurance might affect eligibility. Navigating these benefits requires understanding specific policy details.
Understanding Breast Pump Coverage
The Affordable Care Act (ACA) generally mandates that most non-grandfathered health insurance plans cover breastfeeding support, supplies, and counseling as preventive services without cost-sharing. This provision typically includes coverage for a personal-use breast pump, recognizing its role in supporting maternal and infant health.
While the general requirement for coverage exists, the specific type of pump covered and the process for obtaining it can vary significantly between individual plans. Many plans allow for obtaining the pump up to a few weeks before the baby’s due date or shortly after birth.
Insurance plans commonly cover either a personal-use manual or a standard electric breast pump, and in certain medical situations, a hospital-grade rental pump might be available for a defined period. To access this benefit, a written prescription from a licensed healthcare provider, such as a physician, nurse practitioner, or certified nurse midwife, is almost always a prerequisite. This prescription typically specifies the medical necessity for the pump and may indicate the type of pump required.
Most insurance policies stipulate that the breast pump must be obtained from an in-network Durable Medical Equipment (DME) supplier. These suppliers are contracted with the insurer to provide medical devices and manage billing. Policyholders should consult their plan’s benefit documents or contact the insurer to identify approved DME providers and understand any specific authorization requirements to ensure full coverage and avoid unexpected costs.
Navigating Insurance Policy Changes
Switching health insurance plans means entering a new contract with different benefits, rules, and network providers, independent of the prior plan. A new policy does not automatically carry over benefits from a previous insurer, even for similar services like breast pump coverage. Therefore, reviewing the new plan’s provisions is essential to understand available benefits.
Upon enrolling in a new health insurance plan, individuals should review the Summary of Benefits and Coverage (SBC) document provided by the new insurer. This document outlines coverage for various services, including durable medical equipment like breast pumps, and any limitations or requirements. Contacting the new insurer’s member services department can also provide specific details regarding breast pump coverage.
Some new insurance plans may impose waiting periods before certain benefits, including maternity or durable medical equipment, become active. These waiting periods can range from weeks to months, depending on the policy and benefit. Verifying waiting periods is important to determine when the breast pump benefit can be utilized. Understanding new policy specifics, such as approved suppliers and prescription criteria, is necessary before attempting to obtain a pump.
Criteria for Additional Breast Pump Coverage
Obtaining a second breast pump after switching insurance is not automatically guaranteed. Coverage for an additional pump depends on the new insurance plan’s terms and the individual’s current circumstances. New plans provide benefits based on their own guidelines, rather than replicating benefits from a prior insurer.
One common scenario where a new plan might approve an additional pump is for a subsequent pregnancy. Each new pregnancy generally triggers a new maternity benefit period, including breast pump coverage for the new child. This is considered a new benefit entitlement.
Another circumstance that might warrant an additional pump is a documented medical necessity. This could include a significant change in the mother’s or baby’s medical condition requiring a different pump, or a confirmed malfunction of a previously obtained pump. Such cases typically require specific medical documentation and a new prescription from a healthcare provider detailing the necessity. Policyholders should consult their new insurer’s policy on medical exceptions and appeals.
Steps to Obtain Your Breast Pump
After confirming eligibility, secure a current prescription from a healthcare provider. This prescription must meet the new insurer’s specific requirements, often including the patient’s diagnosis and the type of pump recommended. It is advisable to ensure the prescription is dated appropriately for the new policy period.
Next, locate an in-network Durable Medical Equipment (DME) supplier approved by your new insurance plan. Many insurers have online tools or provide lists of contracted suppliers through their member services. Contacting the chosen DME supplier allows them to verify your insurance benefits and confirm the available pump options.
Finally, the DME supplier will typically handle the submission of the prescription and any necessary authorization forms to your new insurance company. This process often includes verifying coverage and obtaining pre-authorization if required by the plan. Once approved, the supplier will arrange for the delivery of the breast pump, typically within a few business days to a week after processing.