Tag Archives: health insurance

Breast pumps are covered by insurance with no copays! (If you’re willing to do some work.)

When I was pregnant with Judah, I planned to be a 100% stay-at-home mom, so I didn’t invest in an expensive breast pump. It turned out I didn’t need one. I only pumped a handful of times, so a $300 pump would have been overkill.

However, for full-time working moms who want to breastfeed, an expensive double-electric pump is essential if you’re going to have any chance at successfully breastfeeding. That’s why the Affordable Care Act included provisions that require health insurance companies to cover breast pumps and other necessary breastfeeding supplies (and lactation consultant services!) at no cost to the insured (read: no copay). Woo hoo, right?

Well, not so fast.

I will be home full-time for the first 4 months with this baby. After that, I’ll go back to a part-time teaching schedule. As of right now, my schedule will have me on campus two hours a day, three days a week. We’re fortunate that my husband’s teaching schedule is flexible, so he’s able to stay home with the kids while I’m on campus teaching. I didn’t start teaching until after Judah stopped breastfeeding, but this time, I’d like to make sure there are bottles on hand in case baby is hungry when I’m gone. Hopefully, as long as I nurse before I go, the baby won’t need to nurse again until I’m home. But you never know! Since I’ll be away from this baby more than I was Judah, I decided to redeem my 100% covered breast pump.

Unfortunately, it’s not as simple as it sounds.

Breast pumps are sold at most big box retailers. Depending on the model and features, double-electric pumps range from $150-$400. Like all products, some are more efficient and easier to use than others. Some come with fancy features to make things more convenient for moms.

When I heard about the ACA provision, I assumed I’d be able to purchase a pump in a retail store and submit my claim for reimbursement. Wouldn’t that be so simple? That’s not how it works. At all.

First, you have to obtain a prescription for a breast pump from your OB or midwife. My midwife wrote the prescription at my last appointment, and she told me that she’d written it specifically for a double-electric pump. Apparently, if the prescription doesn’t specify “double-electric pump,” insurance companies can insist on only covering inefficient manual pumps, which are not sufficient for moms who will be pumping daily.

Once you have your prescription, you need to contact your insurance company to find an in-network durable medical equipment supplier. But here’s the catch: when I searched for a list of in-network DME suppliers in my area, I found a very short list. I called every one of them. Not a single one offered breast pumps. So I was confused.

I absolutely despise calling my insurance company (I’m always on hold forever, and they are rarely helpful). So my first call was to a lactation consultant at the hospital where I plan to deliver. My hospital is working toward baby-friendly certification, and they have an awesome lactation center that rents and sells breast pumps. I wondered if I’d be able to purchase a pump from them and be reimbursed, since they’re an in-network hospital. Unfortunately, according to the lactation consultant, they will not bill my insurance company directly, but she said I might be able to purchase it there and submit a claim for reimbursement. I’d need to call my insurance company to be sure.

After three different calls, I was given three different answers: maybe, if they’re in-network; yes, because they’re in-network; and finally, no, it would not be reimbursed because even though they’re in-network, they’re not an official DME supplier.

Since there are no DME suppliers in my area who offer breast pumps, the insurance company gave me a list of mail order DMEs that are in-network. I will need to fax or mail them my prescription and insurance information, and they will ship me a pump.

Here comes the second catch: their selection is very limited, almost always out of stock and on back-order (so order early if you can!), and their options are the bare bones models. I will be able to get a double-electric pump that will be sufficient for my needs, but it won’t include any of the extras I would get with a retail pump. I suppose I’m not surprised that’s the case, but I’m disappointed that breastfeeding moms who want to take advantage of this will be so limited in their options.

The earliest my insurance company will allow me to order the pump is 30 days before my due date. Some insurance companies won’t fulfill breast pump prescriptions until after the baby is born, so check with your in-network DME early to see if you can get a head start on the paperwork and order the pump as soon as your insurance company allows. Cross your fingers that there will be pumps in stock, and you won’t have a 6-8 week wait like I will.

I was incredibly frustrated, but I’m sharing my experience to let other moms know that it can be done. If you have a specific pump in mind, and the extra money to spend on it, you might want to go ahead and make the purchase on your own. Unfortunately, I suspect that’s part of why insurance companies have made the process so complicated — they hope women will just purchase a pump out-of-pocket so they can get the exact model they want before the baby arrives without all the hassle. If funds are limited, or you’re insisting that your insurance company honor the requirement on principle (I pay a lot of money in insurance premiums! If the law says they have to cover my breast pump, they’re going to cover it, dang it!), be prepared to do some research, be aware of your rights, and get the ball rolling early.

Have any of you received a breast pump from your insurance company? What was the process like for you?

Oh, health insurance. Why must you be so difficult?

With baby due in the next month, I finally decided to stop living in denial and start dealing with the issue of health insurance for him. Unfortunately, it’s not a simple situation. Because I’m currently covered through my former employer’s insurance on COBRA and my husband is covered by a private insurance policy, we’re trying to figure out the most affordable way to provide coverage for the new baby.

I’m waiting on a quote from my COBRA insurance, but I’m pessimistic about cost. When I first started working at the company, the cost to add only my husband to my insurance plan was over $300. That’s why he ended up with a private insurance policy. Not to mention, my COBRA coverage will run out October 2011. I’d prefer that the baby have something more stable.

My husband’s policy was due for renewal this month, so we were also able to examine his coverage and make some changes. We were paying about $175 a month for pretty comprehensive coverage with a $2,500 deductible. He’s had the policy for three years, and he hasn’t had a single claim — fortunately. However, because we have money in savings and most hospitals are willing to work out a payment plan for high medical bills, we decided that we could safely reduce his yearly deductible.

We chose a plan with a $5,000 deductible. Unfortunately, we’ll have to pay 100% of his health costs up to the deductible, but beyond that, he will be covered 100%. So our maximum out-of-pocket costs for a year will be $5,000. Preventative care such as routine physicals will be covered 100% with no deductible. This reduced his premium by $100 a month.

If we decide to add the baby to his policy, their combined premium will be $250 — an increase of only $75 a month for our total health insurance costs. Well-baby care will be covered 100% as preventative care. That means all of the baby’s check-ups and immunizations will be covered with no out-of-pocket cost, but anything beyond that we’ll have to pay up to $5,000. Between our emergency fund and the option of a payment plan for more expensive medical costs, I’m comfortable with carrying a higher deductible. I’m also much more comfortable with a $75 premium increase instead of $300 a month.

This will hopefully be a temporary fix. I’ve been unable to apply for private coverage since I left my job due to the pregnancy — most private plans don’t even offer maternity coverage, let alone coverage for an existing pregnancy. Once the baby is born, I hope to find an affordable private policy for our entire family. I’ve received some quotes for $300-$400 for comparable coverage for all three of us, but until I can actually apply I won’t know any solid numbers.

The application process for private health insurance is long and arduous, so the baby will need to be added to my husband’s policy immediately to avoid a lapse in coverage. My fingers are crossed that I’ll be approved for a private policy so I can reduce the monthly payment I’m making.


If you have a job that provides you with health insurance benefits, don’t take it for granted. My husband’s employer doesn’t provide health insurance, and I’m self-employed, so dealing with health insurance is a complete nightmare. I’m just relieved that we found a solution that will keep all of us covered without costing us a fortune.

If you’re currently uninsured, do yourself a favor and look into private coverage. Depending on your medical history, you may qualify for surprisingly affordable coverage. Unfortunately, if you have pre-existing conditions, you may have to wait until health insurance reform takes effect in 2014 to qualify for private coverage. If you’ve been uninsured for at least 6 months, though, you may qualify for health insurance through your state’s high risk pool. You can find more information on your options here.

Photo by mkmabus

More insurance company fun! /sarcasm

Oh, health insurance. Why must you make everything so complicated?

By the time I got pregnant, I thought I was pretty prepared for everything. As it turns out, I was not only unprepared for the emotional and physical stress of pregnancy, but there are many logistical issues that I never considered.

Last year, I found out that when a pregnancy spans two separate calendar years (pretty common considering the majority of pregnancies last 9 whole months), you’re responsible for paying your deductible twice. It makes sense in theory, but ugh. What a pain!

I’m lucky in this regard. My due date is December 9. My new midwife (who is fantastic, by the way, but that’s another post) says it’s highly unlikely that my pregnancy will continue beyond 42 weeks. I’m committed to a natural birth, but I’m willing to discuss induction at 42 weeks. That means I will likely go into labor by December 23 at the latest. Since I’ll deliver in 2010, I’ll pay a single deductible. Whew.

It wasn’t until a few days ago that I considered the possibility of a third deductible.

According to several resources, it’s common for hospitals to issue a separate bill for the baby’s hospital care after birth. Once the baby is born, he becomes an individual, and he’ll receive separate care in the hospital. Even in a normal birth that doesn’t require a stay in the NICU (fingers crossed that we’ll avoid that nightmare), the baby will incur his own medical bills.

I also found out that depending on the insurance provider and the policy, it’s possible that the baby will require his own insurance deductible. Blerg. Again, this makes sense in theory, and I can’t believe I never thought about it. But to be fair, you never really think about insurance deductibles for newborns until you’re pregnant.

Some insurance companies include newborns under their mother’s deductible for the first 30 days. Many include the hospital stay after delivery under the mother’s deductible, but well baby care after discharge is separate. It really just depends on the insurance provider and the policy.

My individual deductible is $2,500. I’ve already met my deductible for this year with prenatal care, so I was looking forward to owing $0 after my delivery. A separate deductible for our new baby would change that. Even routine well baby care for a two-day hospital stay can add up pretty quickly. He’d likely reach his own deductible after just a couple days in the hospital, and $2,500 isn’t chump change.

As much as I hate (hate hate hate) calling my insurance company, I needed to know how they would handle my new baby’s deductible. If we were going to owe $2,500 to the hospital after the birth, I’d rather prepare for it than be hit with a surprise bill.

Of course, it’s not possible to call my insurance company and speak to a person without sitting through an impossible automated system that asks 45 questions. Half the time, the automated system doesn’t understand my responses, and I have to repeat myself four or five times. As I’m transferred from department to department, I have to answer the same questions two or three times. There is nothing I hate more than talking — out loud — to a robot. It is a complete nightmare. But I’m lucky to have health insurance at all, even COBRA, so I deal with it.

The conclusion? The baby’s hospital care will be included under my deductible. Once we’re discharged from the hospital, he will become an individual policy holder with his own deductible.

If you’re pregnant (or considering getting pregnant), I suggest you check with your insurance company to find out their policy for handling deductibles for newborns. It’s better to be prepared than surprised!

Photo by joannao

Health insurance hijinks

Remember a few days ago when I said I’d like to have a midwife, but they’re not covered by my insurance? It turns out I was wrong. Well, EYE wasn’t wrong so much as my insurance company was wrong. Amazing, right?

Yesterday, I set about the task of finding a new doctor in Fort Wayne so I could make my next appointment with them. When I first started looking for a doctor (or midwife), I started my search with my insurance company’s directory of in-network physicians. For an in-network physician, my out-of-pocket costs will be $2,000. For someone outside the network, it would be $4,500. Big difference.

To be honest, I didn’t try very hard to find a midwife. I ran a search for certified nurse midwives (a specialty that was included in the drop-down menu for my insurance company’s directory search). When it said there were zero in-network midwives in the entire state of Indiana, I was skeptical. But I chose an OB, and moved on. I decided I’d give the OB a shot, and if I was unhappy with her, I’d explore switching to a midwife once we were settled.

When I started my search for midwives in Fort Wayne, I found a practice that interested me. Their website listed my insurance provider as one of the plans they accept, so I called to confirm. They verified that yes, they accept my insurance. I asked if it was possible that the midwives would accept different insurance plans from the obstetricians, and she said no. All physicians, midwives, and nurse practitioners in their practice accept the same insurance plans. Great!

I assumed that there was a glitch in the providers directory on the website, so I called to verify that the midwife I wanted was in-network.

As a brief aside, can I just say how much I hate talking to a recording? It’s bad enough when I have to choose my options by hitting a number on the keypad, but at least I don’t have to repeat myself a million times. My insurance company’s recorded message is the WORST. Every time I call them, the menu takes me in so many circles that I’m dizzy and frustrated by the time I talk to an actual person. I’ve actually started repeating, “Representative” over and over again just to avoid the mess.

When I finally got to talk to a real live human, I explained my situation. He responded flatly, “We don’t cover home births.”

Me: “Um. That’s fine. I don’t want a home birth. The midwife I want delivers at an in-network hospital.”

Him: “We don’t cover midwives, because they’re not licensed to deliver babies legally in Indiana.”

Um. WHAT. At that point, it became clear to me that the guy had absolutely no idea what a midwife is. So I asked as politely as I could if I could speak with someone who does, in fact, know what a midwife is. He was pretty annoyed by the request, but he transferred me.

I didn’t have much luck with the next representative. He ran a search in the database, probably using the same search tool I had used, and told me flatly that the provider I want isn’t in network, because there are no midwives in network. I told him what the insurance specialist at the midwife practice had told me about all of their physicians accepting my insurance, and he told me she was wrong. Okay.

Frustrated, I hung up and called the midwife practice again. I told the woman what happened, and she was confused. Apparently, they bill my insurance company frequently. It’s a major one, and a lot of their patients are on it. She even asked about my specific plan, and said that yep, a ton of their patients are on my very same plan. WTF?!

At this point, I was irritated and determined to straighten it out. I called the insurance company again, dealt with the insufferable menu options, and finally got to a person again. Thankfully, this representative was not a total idiot.

He explained the problem, which actually makes complete sense. Midwives don’t come up in the physician search, because they’re not physicians. They practice and bill under a physician. In that case, I don’t understand why “Certified Nurse Midwife” is a search option on their website, but whatever. He explained that I needed to find out my midwife’s attending physician, and search for him or her. If the physician is covered, the midwife is, too. Duh. I’m glad that SOMEONE at my insurance company understands how it works, because the previous two people to whom I spoke had NO IDEA.

The moral of the story? If you’re hoping to have your birth attended by a midwife, search for your midwife’s attending physician. And don’t expect your insurance company to make things easy on you.

Photo by mkmabus

A rock and a hard place

It’s time for us to deal with the part of moving that I’m dreading most: health insurance.

We were uninsured for a year after we moved to North Carolina. I was working part time in retail, Tony was a student, and we were trying to get by on a tiny income. In hindsight, I realize how stupid it was for us to forego coverage, especially since we later learned that we could have afforded high deductible catastrophic coverage. It’s not ideal, but it’s better than nothing.

Now as we look ahead at a lot of unknowns, we have to figure out what we’ll do next. Being uninsured isn’t an option for us right now. We’re grown-ups now, which means we accept that health insurance is a must.

Tony is currently covered by a private policy. His coverage is fairly comprehensive, and includes co-pays for office visits and 100% coverage for preventative care. He hasn’t made a single claim in two years, which is a good thing (knock on wood), but makes me wonder if he may be overinsured just a bit.

We’re considering downgrading his coverage to a mid-grade deductible with 100% coverage for preventative care, 100% coverage after the deductible is met, but no coverage before the deductible. If he needs to go to the doctor for a sinus infection or other minor problem, we’ll pay 100% of the cost up to the deductible. But if something more serious happens, he’ll be covered.

As for me, I’m worried that I’ll be denied private coverage due to my history with anxiety and depression. I also don’t want to deal with the stress of shopping for private insurance as we’re moving and job searching and dealing with a million other stressful situations. Tony is already covered, but getting him signed up for a private policy was a nightmare. Five months and several physicals and questionnaires after he applied, he was finally covered.

I have absolutely no desire to go through that, especially considering my history of mild anxiety and depression. I don’t know that I could stomach being denied coverage for my “condition.” How am I a bigger risk because I decided to seek treatment? I would think that my commitment to staying healthy and happy would make me a lower risk. In my opinion, it’s discriminatory and wrong. But I digress.

My other option is to continue receiving the same health care I currently receive though my employer with COBRA. I’m happy with my insurance, and it includes a $500 HRA provided by my employer (I would continue to receive that benefit). But it costs double what I’d pay for (somewhat) comparable private coverage.

There are just so many questions with private coverage, though. Will they approve me? How long will it take before I’m covered? And how high will my premium be considering my history? The online quotes I’ve received don’t ask about pre-existing conditions, which makes me think that even if they do cover me despite my history of anxiety, I’ll still have a higher premium.

Because of all these factors, we’ve made the decision to continue my coverage through COBRA and decrease Tony’s coverage a bit to ensure that he has a relatively low deductible, but also a lower premium. As long as his deductible is lower than what we have in savings, he’ll be completely covered.

Honestly, I was hoping this wouldn’t be an issue. I know I don’t normally get into this sort of thing here, but I was hoping real health care reform would pass before May, and at the very least, it would be illegal for health companies to deny me based on my minor anxiety issues. But unfortunately, we’re not counting on that happening now.

This hasn’t been a fun decision to make, but we recognize that our health is a priority, so we’ll just have to deal with the high cost of insurance right now. Here’s hoping it’s temporary.

Photo by bryanchan