That breast pump might be free!

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Here is a little known fact: that expensive breast pump you need might be covered by your health insurance.
One mom-to-be in Downtown Brooklyn found out how to do this and shared her advice with us. Here is what she found out:

I worked with a national durable medical equipment (DME) company, and they took care of all of the paperwork, the authorization from my doctor, and the pump shipped for free. I did not have a co-payment, or any other cost for that matter. I wanted a Medela pump, and I was offered the option of 6 or 7 models, one being the one I wanted. I have insurance with Empire Blue Cross Blue Shield EPO but it is very likely that breast pump authorization will vary by insurance carrier. It is important to know that this may work with other DME companies, I just happened to be referred to Edgepark by a friend. You may have a DME company  that you already have a relationship with, so check with them about breast pumps.

Here’s the series of steps I went through to get it covered:

1. I called Edgepark Medical Supplies, a company that works nationwide (1.800.321.0591).  It’s better to first work with a representative on the telephone, as there are specific questions to answer.
2. When you get a representative on the telephone, be prepared with your insurance card as they will ask for ID number, group number and various other information on your card. You should also have all of your OB’s contact information, including address and telephone number. Your doctor will most likely have to authorize this request.
3. Edgepark will ask if your baby has arrived. Some insurance companies will require that the baby already have arrived before they authorize the pump. I am due in February, so the insurance type I have did not require this.
4. They will ask you for your diagnosis. This threw me off- but the representative offered some options, such as going back to work after baby is born and needing to supplement, or the baby having trouble latching.
5. They will ask you what model of pump you would like to order. Be ready with the model that you want, but also be ready with backup choices. I was in front of a computer, and was able to Google the options given to me to make the most informed choice. The representative was very patient with me.
6. You are able to provide your e-mail address for updates on the status of your order.

After you’ve completed your call with Edgepark, you then wait for news to see if your pump is authorized by your insurance company. This process took about 3 days between the initial call and the authorization from my doctor, and my pump will arrive in a few days. Incidentally, Edgepark has terrific customer service, and I received e-mail updates every step of the way.

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20 Comments

  1. I tried to go through Edgepark but when my insurance wouldn’t cover it they never called me to tell me this was the case. My account summary on their site kept showing my order as pending and because pumps are in such high demand I just waited… and waited and waited! I panicked when my due date came and went and called them just for them to tell me that they are not contracted with my insurance. I guess I’m just warning people to not completely leave it up to Edgepark to communicate because they won’t. It seems nice that they do the leg work for you, especially since navigating insurance’s customer service lines can be such a pain, but now I have to scramble to see if I can get one through other channels.

  2. Please keep in mind that with the ACA and coverage for breast pumps, particularly if you have ha your insurance plan for a while or if you have it thru your employer, your insurance plan may be what is considered as “grandfathered” which means it keeps in effect the old rules. If this is the case you may only be able to get coverage for a pump if the mother is discharged from the hospital and the baby remains due to illness or other medical reason, and also may be determined based on anticipated length of separation. Please check with your insurance company first. If you are in an employer group plan and this is the case, check with your employer about changing the plan, if you are in an individual (aka non employer group plan) check with your insurance about getting into a nongrandfathered plan. Do NOT assume that the ACA automatically grants you coverage. Do your research. Trust me!!

  3. Would this work with Total Care? Hmm

  4. I called my insurance comp, and they told me it was only covered if my doctor recommended it and that he would have to write a prescription. They gave me a provider that carried breast pumps and told me I couldn’t do anything until 4 weeks before the due date. At exactly 4 weeks to go called and right away they asked me what pump I wanted. I told them the Medela pump in style advanced. They told me it would take a while because that is not the standard pumps they carried. I said it was fine and I would wait. 3 days later I got a call that said it is being shipped and will be here in 5-7 days. Yah! So easy and I didn’t even have to talk to my doctor. It will be here before the baby. Oh and just so you guys know I live in California and have great health care west Cigna insurance.

  5. I just ordered a pump through Edgepark…the only 2 they have left are here: the Ameda Purely Yours Electric Double breast pump and the Playtex® Double Electric Breast Pump. I ordered the Playtex. Reviews weren’t great, but my insurance covered all of it. I have a hand-me-down Medela double breast pump in case this one doesn’t pan out. Good Luck. They are going fast!

  6. I believe under the new Obamacare laws all insurance companies have to provide free pumps if you call and ask.

  7. I know must insurance companies will only cover once the baby has been delivered. Also must be from a local, in network dealer.

  8. I was wondering if anyone knew if medical pregnancy covered a breast pump? My work doesn’t provide insurance so I had to use this! But I was wondering if anyone had any idea about it?

  9. Hi I live in California and have a Cigna insurance. Would I call my insurance or the recomended edge park medical supply. I desperately need a pump to go back to work. I’m due end of march.

  10. Just want to clarify some on this as I work for a dme company in rochester ny. When calling your insurance company about the pumps, most customer service reps will quickly tell you they are covered only when medically necessary, which is part of their old coverage criteria. Ask to speak with a supervisor. They will tell you they are covered in full, not even subject to a deductible or c/p as the pumps are now mandatory. They used to only cover manuals unless proven by your doc that it wasn’t working. No script needed, no c/p, no deductible! Yayyy :) 585-227-8750 call if you need a supplier!

  11. I just pinned this, thank you!

  12. Hi ladies. I am currently going through this process to see if I can get a breast pump covered through my insurance as well. I would love to know which specific pump you all were able to get? I’m interested in a couple of the Medela’s. Thanks!

  13. OMG- I’m so happy for you! I’m beyond thrilled that you found your breast pump was covered totally. Thank you for letting us know that it worked for you post-birth, but how great the Edgepark did all the paperwork for you. Hooray and much congratulations on the birth of your baby!

  14. I have Empire BC/BS and my breast pump was covered in full, I got a Medela through Edgepark as well. The only trick for me, however, was that they wouldn’t cover the purchase unless it was done just after the baby was born. After I made the order and filled out the paper work, they contacted my doctor to verify the birth and my need for the pump. Once they had verification, they sent the pump in the mail.

  15. Thank You very very much for the info! Thats what i was looking for!=)))

  16. Thanks so much for the information!
    The only thing is, what if you don’t need it when the baby’s born? Oh well, then you can give it to a friend, I guess.

  17. Ah, Karen, the trick is to do it before the baby comes. :) My baby is not due for another 3 weeks or so. When I asked my doctor if I should wait until after the baby comes, she said, “Why wait if insurance will cover it? If there’s going to be paperwork and hassles, you might as well use your time now to take care of it!”

    :)

  18. That’s so helpful Donna. It’s great to know about another provider and also that it worked for you too! Thank you for sharing your experience.

    How you both figured all of this out while being a new mom- I don’t know! I was so preoccupied with figuring out to get food I couldn’t think about anything else. I was starving the whole time I was nursing!

  19. Hi! I also made this work through my Empire BCBS EPO insurance as well. I didn’t work with Edgepark, but I used Apria Healthcare. While they offered the Ameda Purely Yours for purchase through their website, for the insurance claim to come through, you have to call them directly and it seemed their local office only carried the Medela Pump In Style Advanced. I found them through my insurance’s website, under Durable Medical Equipment (I am covered 100%), and looked through the list of providers to see if they would get me a breast pump. I had my doctor’s note already, citing the need for a breast pump as I plan on going back to work and I travel a lot. When I called Apria, they obtained my insurance info, name, address, and they supplied me with a fax number and a person’s name for me to send them my doctor’s note. Before I knew it, they had verified the request with my doctor, confirmed my address, and my pump was at my door, 2 business days after I had made the initial call.

    Good luck! Don’t be discouraged if you can’t get your insurance company to verify they can do this in the very beginning. I had to call back several times to get a representative who knew what was going on. Persistence!

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