The current healthcare law covers breast pumps for new moms—so why are so many moms-to-be still registering for them?

According to the baby registry site Babylist, the number of registries that include a breast pump has gone from 17 percent in 2014 to over 23 percent in 2016—even though the Affordable Care Act (AKA Obamacare) requires insurance to cover breast pumps. The site’s research found that women are still registering for pumps because their insurance companies are complicated to deal with, they don’t know that they have breast pump insurance benefits, or their insurance doesn’t cover the one they really want.

Mom-to-be Gretchen Evans experienced this frustration—she’d placed a call to her insurance company, only to find out they didn’t cover pump purchases, only breast pump rentals, which left her with an ick factor. “The woman I was speaking with agreed with everything I was saying but it was the policy of the company and out of her hands,” Evans tells Parents.com. “She even stated she wouldn’t be comfortable with the insurance option.” Ugh, so what’s a preggo to do? Here’s how the experts told us to make sure you get the most out of your insurance benefits.

Breast pump laws

The current healthcare law does cover breast pumps, explains Tina Sherman, campaign director for the Breastfeeding and Paid Leave Campaign at the women’s advocacy organization MomsRising. “Under the Affordable Care Act [ACA] breastfeeding moms are eligible to receive lactation support and breastfeeding equipment and supplies,” she tells Parents.com. “Breastfeeding equipment is based on the recommendation of the woman’s healthcare provider and may include but is not limited to, double electric breast pumps, including pump parts and maintenance, and breast milk storage supplies.”

The problem is that insurance companies interpret this all different ways—some only cover certain brands or models, some require you to get them from an in-network “durable medical equipment supplier” (in other words, not at Target or Babies”R”Us), some may allow you to submit for reimbursement after you buy it, and some require a prescription from your doctor. In addition, when you can buy your pump varies, too—some make you wait until after your baby is born, even though that’s a major hassle. Older plans written before the law, or “grandfathered,” don’t have to adhere to the ACA, although they still may offer some benefits.

The bottom line? You have to call them to find out. “It’s important to contact the individual plan in advance to verify any unique processes and requirements,” Abbie Leibowitz, MD, Chief Medical Officer, Founder and President Emeritus of West’s Health Advocate Solutions, tells Parents.com. “Do not purchase a pump on your own without first confirming the preferred process with the plan, as this may disqualify you from being reimbursed.” He advises calling rather than just reading what’s online, as individual plans can vary.

What to ask

If you’re getting the runaround or are still confused, see if you have access to a health advocacy service through your insurer or your employer, Dr. Leibowitz suggests. They can help you sort it out. “Similarly, if you have health insurance through your employer, your human resources or benefits representative is a great resource,” he says.

Also, talk to your doctor about your individual pumping needs, as this might help push through your pump coverage, especially if your insurance requires a prescription. “If you will be pumping often and require an electric pump, be sure the prescription indicates this to ensure you are covered with the most appropriate pump,” Dr. Leibowitz says.

Picking a pump can be confusing—you want to make sure you have the right one, not just the one insurance says it will pay for. “The type of pump you get depends not only on your needs, but on your body—breasts and nipples come in all shapes and sizes, and different pumps can be better with different supply levels,” Sam Rudolph, mom and creator of the unique smart pump Babyation, tells Parents.com. “The pump that’s best for you also depends on your lifestyle. I know some moms that are very happy with their manual pump because pumping isn’t part of their daily or weekly routine. On the flip side, moms that hook themselves up to pumps multiple times each day have a different set of needs.” Your doctor or a lactation consultant—whose services might also be covered by insurance—can help you decide.

OK, so what if you want a pump your plan doesn’t cover? Check if you can be reimbursed up to the amount your plan will cover. If not, you might have other options. “Beyond insurance, few moms know that they may be able to use pre-tax dollars,” Melissa Gonzales, managing director of breast pump manufacturer Medela USA, tells Parents.com. “Moms may be able to use their flexible spending account (FSA), health savings account (HSA) or health reimbursement account (HRA) to help cover the cost.”

It’s a lot of legwork to manage when you’re trying to get ready for a new baby, but doing your research now may save you money on your pump later. Gonzales has a handy list of questions to ask your insurance company:

  • What type of pump can I get (hospital-grade rental pump, double or single electric personal use, manual pump)? Do I have brand options?
  • Do I have to get the “recommended” pump or can I choose to purchase one out-of-network and submit the receipt for reimbursement? If yes, what amount will I be reimbursed? Is there a dollar limit on coverage for breast pumps?
  • If I have already obtained a breast pump, can I submit a claim for reimbursement?
  • When can I get my breast pump—before or after giving birth?
  • Where can I get my breast pump? Does it have to be from a designated place (an “in-network” provider) or can I choose where to get it?
  • Will I need a prescription from my healthcare provider?

Episode 8: Understanding Harassment in the Workplace

Harassment and disrespect can have a detrimental effect on the workplace. Understanding the difference between insensitive behavior and harassment and learning how to respond can decrease liability for organizations. In this episode of Health Advocate’s Ask the Expert series, Matt Verdecchia, Senior Trainer and Organizational Development Lead with Health Advocate’s EAP+Work/Life division, discusses how organizations can prevent and address harassment in their workplace.

Streamlined website and mobile app to be deployed at thousands of organizations and available to millions of employees and members nationwide

Plymouth Meeting, PA, August 2, 2017 – West’s Health Advocate Solutions, a leading clinical health advocacy company, announced today the latest update of its interactive online member engagement experience. The website and mobile app both enable members to access all of their Health Advocate services in one place, seamlessly connecting them to experts and resources to help them get the information and assistance they need to navigate the healthcare system, access care and improve their health.

Developed by top informatics experts, Health Advocate combines its powerful, unique data analytic abilities and proprietary algorithms with machine learning to drive features of the new site and app, automatically delivering personalized recommendations to members, encouraging them to take specific actions unique to their needs and goals. The same information is also available to Personal Health Advocates, leading to a better member experience and improved outcomes.

Abbie Leibowitz, M.D., F.A.A.P., Chief Medical Officer, Founder and President Emeritus of West’s Health Advocate Solutions, said, “In order to effectively meet members where they are in their health and wellness journey, it’s critical that we provide even more convenient access to our services and programs. With this latest release, we can more easily connect members with excellent, expert personal support, along with providing the ability to utilize a number of new digital tools to track and manage their health.”

The new, easier-to-use member website and app combine the guidance of Personal Health Advocates with data-driven technology, providing personalized support while driving increased engagement. As an all-in-one, integrated hub for both Health Advocate programs as well as other health, wellness and benefits services, it is now easier for members to connect with all of their benefits via the channel that works best for them – online, via the app or by calling a Personal Health Advocate.

Since the platform was first introduced last April, Health Advocate has identified more than 2.5 million member-specific actions to help users take steps toward better health. As an industry leader for nearly 20 years, Health Advocate understands what members need to effectively take charge of their health.

Key features of the new online member experience include:

  • One-step access to 24/7 personal support, including the option to immediately call or message an Advocate for one-on-one guidance and assistance
  • Personalized to-do lists and alerts and company-wide custom messaging capabilities
  • Real-time Health Advocate case status and the ability to instantly upload documents
  • Access to member-specific information such as benefits and gaps in care
  • Incentives status and tracking for wellness and other activities
  • Multi-channel outreach capabilities with option to choose preferred methods of communication (i.e., mobile push notifications email, phone, etc.)
  • Pricing transparency tool to compare costs for medical procedures and prescriptions
  • Useful health and wellness information including workshops and challenges
  • Mobile app access through touch ID

A recent Health Advocate study* found that forty percent of employees cite the lack of “communication personalized to my specific health needs” as a flaw in their organizations’ benefits initiatives. Further, employees participating in the survey indicated they prefer a mix of available communication channels, such as an online portal, website, email and live support by phone, depending on the issue at hand. Offering a personalized, multi-channel experience that meets employees’ specific preferences and needs drives engagement in health and benefits.

Health Advocate recently presented a soft launch of the new platform at the Society for Human Resources (SHRM) 2018 Annual Conference in New Orleans. The new member website and mobile app are now available to all Health Advocate members online or via both the Apple iTunes and Google Play stores. To request a demo or more information, please call 866.799.2655, or email us at: info@HealthAdvocate.com. And to learn more about the platform, view our video here.

About West’s Health Advocate Solutions

West’s Health Advocate Solutions makes healthcare easier for over 12,000 organizations and their employees and members nationwide.

Our solutions leverage a unique combination of personalized, compassionate support from healthcare experts using powerful predictive data analytics and a proprietary technology platform including mobile solutions to provide clinical support and engage members in their health and well-being.

Our members enjoy a best-in-class, personalized concierge service that addresses nearly every clinical, administrative, wellness or behavioral health need. Our clients benefit from high levels of engagement, improved employee productivity and health, and reduced medical costs, while simultaneously simplifying and upgrading their health benefits offerings.

For more information, visit us at www.HealthAdvocate.com

*Source: Health Advocate, “Striking a Healthy Balance” survey report, 2016.