Affordable Care Act and Breast Pumps

Through the ACA, insurance companies are required to cover a breastpump for women who have nursing babies.  I am not going to get all law-tech-bureaucratic on you, but since I recently went through the process and have had a lot of inquiries on how it worked for me, I thought I would share my experience.

It is my understanding that even though this is something insurance companies are "required" to offer, the follow-through is what varies from company to company.  Some only allow a manual breastpump; some allow a higher-quality, hospital-grade pump if your baby was premature.  Still others set the fee of what they will cover, and if you go over that with upgrades or a higher-level pump, the difference is yours to pay.

After Ezra was born in April and we were dealing with his tongue and lip ties (which I wasn't aware of yet), I called my insurance company (Anthem Blue Cross) to see about getting a pump.  They gave me the information for two DMEs (durable medical equipment suppliers).  I was in a lot of pain and experiencing a lot of engorgement.  I was desperate!  I called one company, and even their hold message stated they were backed-up for pump orders.  I hung up and called the other DME.  After some waiting, I got through.  They only offered two pumps: Playtex and Medela.  Coming from a breastfeeding advocacy background, this wasn't good to hear.  My issue with Playtex:  We often counsel women not to buy pumps from companies that make bottles -- the research and science isn't there when it comes to putting together a breastpump that works well.  My issue with Medela:  They are no longer WHO-code compliant (easy to understand info here), and while that isn't the biggest deal to some, it is something very important to me. After a lengthy conversation, exchange of a lot of information, and a hot cell phone to my head (hot baby to my chest, hot engorged breasts), I chose the Medela pump.

I waited a week, and after not hearing from anybody, I called the DME to see what the status was.  I was told I needed to pay around $80.  Now I had been told by my insurance company I would pay 20%, so $80 for a $250ish pump seemed wrong to me.  I talked to someone else in some other department, and she said they would look into it and get back to me.  What really must have happened was, the order got cancelled, because I never got a breastpump, and they never got back to me.  But by then, I was feeling much better and we had worked some of our issues out.

Fast forward to about a month ago.  I was at a LLL meeting and a mother said she had just ordered a Hygeia pump through her insurance and they covered the whole thing at 100%.  I then learned, we had the same insurance!  This was her advice:  Contact Hygeia directly and tell them you want their pump.  I did, and a week later, I got my pump, nothing paid out of pocket, and I already have some milk in the freezer!

Not everyone's process will be that easy.  It is worth a try, though. My understanding is, you have from your third trimester until your baby's first birthday to get a pump.  I didn't think about getting one before birth because I have been trained and ingrained to counsel women NOT to buy pumps while pregnant.  It is often on that baby registry -- a Medela Pump in Style (PIS).  With my childbirth ed classes I have suggested, if a woman isn't going back to work or school immediately, to hold off on buying a pump. With more time and a meeting with an IBCLC, often a women can better determine what type of pump will fit her needs best, versus the PIS simply because that is the one she has heard of, and her sister/best friend/next door neighbor used it, and maybe even someone is giving her their old pump, so she's set.

The thing about the PIS is, it is not the best pump out there -- like we say about carseats, the best carseat for your child is the one that best fits your child AND your car.  Same with pumps.  The best pump is the one that best fits you, not only physically (nipple size) but also functionally (are you going back to work or will you just need some milk for date night?).  Pumps are pricey...they aren't always something needed before a baby is born. In the beginning, mom and baby are supposed to be determining how the relationship goes, how to latch, how often to feed, how much milk, etc.  The pump, under normal circumstances, doesn't need to be a part of that early relationship.  If a woman finds herself pumping, it is often because there are some adjustments needed due to soreness or pain, and that is where a LLL Leader or IBCLC can come in handy.  If you have a premature baby, or a baby who is unable to latch, of course a pump is what you need to protect the milk supply until baby can return to the breast, so don't think I am saying it always goes smoothly -- I know it doesn't.  In situations like that, though, a hospital-grade pump, which needs to be rented, is almost always going to be a better choice, so you still wouldn't miss out if you hadn't purchased a pump before birth.

Back to the giving-away-of-the-old pump:  I admit, I used my sister-in-law's pump 14 years ago, when my baby was in the NICU for two weeks, and I was grateful to have it.  I knew nothing about pumps, barely anything about breastfeeding.  At that point it had been used for three of her babies, and I am sure it had logged many, many hours.  I don't worry that I could have cross-contaminated my milk in there (the PIS is an open-system, which means milk could potentially get into the motor and come in contact with the next mom's milk), but I probably should have worried about the potential for mold growth and my sick NICU baby's health, or even bugs that can get into the motor(yes, cockroaches can visit and maybe even stay).  Pumps are so expensive, though, it isn't unusual for us to want to share them when we are done, or to even sell them to strangers.  Please, don't.  Not if your pump is designed as a single-user item -- treat it like nose-hair trimmers -- you wouldn't share those with anyone, would you?

Hygeia knows when you spend so much on something and it still has life left, you are likely to share it -- and their closed-system allows this simply by having the next woman purchase her own pump parts -- the tubing, the flanges, the storage containers.  Ameda also makes a closed-system pump.  Bailey is another great quality, lesser-known company that makes pumps.  Like I said before, just because Medela is the best-known, doesn't mean they are the best for you.

Once you decide you want a pump, check out who your insurance company's DMEs are; if they have a pump you like, then go for it.  If you want more choices, try contacting the pump company directly to see what DME they suggest.  I just have to say:  The amount you can pump does not determine how much milk you have -- some women don't respond well to pumps, that is a fact.  If you need help pumping or breastfeeding, contact someone -- you don't have to figure this all out on your own.  LLL Leaders can answer questions and provide information about how to pump more successfully, and a personal consultation with an IBCLC can be invaluable when you are tying to figure out the hows and whys and whens of pumping when you are getting ready to go back to work -- they are a wealth of information.

I do not have any relationship with Hygeia, I am just super-impressed with the measures they take to make their pumps relevant in a market where $200 pumps could essentially be tossed in landfills if they were truly being used properly. 

I would love to hear about your experiences with obtaining a breastpump through the ACA. 

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