Getting A Breast Pump Through Insurance? Understand Your Insurance Coverage

Allowable Amounts for Insurance Breast Pumps

The “allowable amount” is the dollar amount that is usually considered payment-in-full by an insurance company and your network of healthcare providers. In other words, it’s the maximum amount your insurance company will pay for a product or service.

An allowable amount is a rate that is pre-negotiated by your insurance plan (rather than the “retail price” for that service or product). The allowable amount for a breast pump can vary greatly from one insurance provider to the next - so the breast pumps that are covered for you may be different than the ones covered for your friend.

Depending on your specific insurance plan, you may be responsible to pay out-of-pocket for the difference in cost if an item exceeds your allowable amoun For example, some insurance plans cover a breast pump and pump parts, but not a bottle cooler or a bag to carry the pump.

1 Natural Way will always let you to “upgrade” your breast pump by contributing an out-of-pocket amount, as long as your insurance plan allows it (some do not).

Free Breast Pumps

You see it promised all the time, but can you really get a free breast pump? In most cases, yes, but it’s never a guarantee. This also has to do with your allowable amount.

If your insurance’s allowable amount is enough to cover a breast pump in full, then you will likely be able to get one (or a few choices of pumps) at no cost. Other conditions may apply to your plan, however. See the What’s Covered section below for more.

Primary vs. Secondary Insurance

Some of us are covered by two insurance plans - in which case, one is considered primary and the other, secondary. If you have coverage under two plans, a claim must be submitted to your primary insurance first. In some cases, the second plan may assist in helping to cover the remainder of what the first plan doesn’t cover.

How can you determine which insurance is your primary coverage? The general rule of thumb is that primary insurance is related to employment. If you have medical insurance through your employer or you are covered under your spouse’s work plan that is usually the primary insurance. If you have coverage through your employer and your spouse’s employer, your employer plan would be primary.

If you have two insurance plans, and are applying for coverage for a breast pump, accessories, compression stockings or lactation visits, we can help you figure out which plan is primary. If both plans offer coverage for these products or services, there’s a good chance your secondary insurance will pick up some of the balance (if there is one) after your primary insurance has processed the claim.

1 Natural Way can only submit a claim to your primary insurance carrier. However, you may be able to submit your receipt to your secondary plan to seek reimbursement for the balance. Please check with your insurance plan for their guidelines.

What’s Covered

If you have an ACA accredited health insurance plan, the insurance provider is required to provide coverage for maternity and newborn care, which requires the inclusion of breast pumps.

There are, however, some plans that are “grandfathered,” meaning that they existed before the ACA and, therefore, are not subject to its requirements. Some states also provide minimal coverage through their Medicaid/MCO programs.

It’s also important to remember that an insurance breast pump doesn’t always mean a double-electric breast pump. Although the vast majority of insurance plans cover a double-electric pump, there are some that offer single-electric pumps, manual breast pump or breast pump rentals. These offerings are still considered breast pump coverage under the ACA.

Additional Products and Services through Insurance

Some insurance plans provide coverage for other maternity-related products. These may include:

• Breastfeeding Supplies and Pump Accessories - Some new moms can receive insurance-covered breast pump accessories and breastfeeding supplies. At 1 Natural Way, we call this our Resupply Program, because we deliver the parts and supplies you need each month right to your door.
• Postpartum Recovery Garments - Postpartum recovery garments assist with healing and recovery by providing medical-grade compression to help reduce swelling and soreness.
• Maternity Compression Stockings - Compression stockings can reduce swelling and discomfort in the legs and feet before and after delivery, not to mention lowering the risk of developing varicose veins and blood clots.
• Prgnancy Support Bands - Sometimes known as belly bands, pregnancy support bands offer support and stability to help you stay active (and more comfortable).
• Lactation Consulting - Moms receive the personalized support they need to achieve breastfeeding success through one-on-one, online lactation consultations

We’ll Provide You with Options

All you have to do is fill out our form and we’ll let you know which models your insurance plan will cover. It’s that easy! And, of course, we’re here to help if you have any questions not covered on our website.

About the Author

Paige Ames is 1 Natural Way's Contract Administrator, working with insurance providers to find out what benefits moms can receive through their insurance plan. In addition to benefits, Paige is also very knowledgeable about the breast pumps and pumping accessories. Because of her range of knowledge, you can find her educating moms at online baby showers and on podcasts like the Army Wives Network. Paige is mom to one beautiful daughter. She enjoys gardening, going to the movies and spending time with her family.