Getting the Breast Pump You are Entitled To Without Losing Your Mind
The Affordable Care Act made a number of improvements to women’s health care, including requiring insurance plans to cover birth control without a co-pay and to cover breastfeeding support, counseling and equipment. New York has further deepened protections for women by requiring that pregnancy be considered a “qualifying event,” allowing uninsured women to get access to health insurance when they find out that they are pregnant outside of open enrollment. While these all are useful protections, too many women do not know how to avail themselves of those protections when they most need it. This post includes tips to help ease your navigation experience with all health insurers.
Navigating the space between the requirement that insurance plans cover breastfeeding support and getting that support is exhausting. Moms and their partners spend hours on the phone having conflicting conversations with customer service representatives, leading to deep frustration. As with many of the protections of the ACA, the law creates the rules and requirements, but the insurance company carries those rules out according to their own procedures.
As journalist Ester Bloom discovered, the rules set by the insurer to get your free breast pump may not be so easy. “This morning, as I took a break from work to pump, I called my health insurance company to try to understand why I received notice from them that my claim for the very pump I was using — purchased as per their instructions, from the company they directed me to and off of a list of approved options provided to me by that company, which I had been promised would, and according to the laws of this great nation must, be free — had been denied.” This Kafka-esque communication may sound familiar to people who are used to dealing with their insurers.
Insurers’ rules can be unclear and not intuitive. “Medical necessity” does not mean what your medical professional thinks is necessary, and “free breast pump” does not mean you can get any breast pump for free.
To figure out how to gain access to a breast pump, you need to know your insurers’ policy for getting your free breast pump. The best place to find your insurer’s rules for all policies and procedures is in your member handbook. This is not the brief one or two-page document insurers provide with an overview of covered benefits. The member handbook, sometimes referred to as the certificate of coverage, is a multi-page document that outlines the rules for everything from requesting pre-authorization to appealing a denial. Unlike the basic overview of benefits, this is not a document you generally can access publically, you must log onto your insurance website as a member. If your member handbook does not have the answer, you can call your member services number to learn their procedure.
If you have trouble learning your insurers’ procedure for accessing a breast pump or getting the pump covered for free, here are some basic tips:
Keep notes. Whenever you call your insurer, it’s a good idea to keep notes. Keep track of the date and time you spoke to a representative and their name, if possible. This is useful for you, if you get stuck in a series of multiple conversations with different representatives and if you end up getting incorrect information, you can use this document to pinpoint when.
Speak with a supervisor. If you get obviously incorrect information from a customer service representative or find yourself arguing with them and getting nowhere, take a deep breath and calmly ask to speak to their supervisor. As with so many things, there is a wide range of knowledge and ability amongst insurer’s customer service representatives and if you speak with one who is not helping, there is no need to keep banging your head against the wall.
File a grievance or complaint. If your insurer is charging you, or you are just unable to get a breast pump following the instructions given, or even having a problem getting the insurer to give you the necessary directions, file a complaint. Filing a complaint online takes only a few minutes and helps make sure that the necessary government agencies understand if there is a problem.
File a grievance directly with your insurance company by calling member services.
Department of Financial Services—complain to this agency through their website.
New York State AG—complain to this agency through their website. Note: the Attorney General requests that you first file a grievance with your health insurer.
Getting a breast pump paid for by your health insurance is a challenge, but these tips can help you get it done with less stress.