Wondering how to get a breast pump through insurance? This is a common concern for mamas who want the ability to pump without breaking the bank. The good news is, your insurance company may cover the breast pump of your choice.
How to Get a Breast Pump Covered by Your Insurance
The first step to get your breast pump covered by your insurance company is to look up the details of your policy. If you have online access to your plan info or a booklet explaining coverage, check there first. These details should explain whether breast pumps are covered under your specific policy.
Call Your Insurance Company
If you’re unable to find plan details or wish to confirm coverage, give your insurance company a call. They’ll be able to answer any questions you may have about breast pump coverage, which breast pumps you’re eligible for and when you might receive your pump.
Willow Tip: Already purchased your breast pump? You may qualify for reimbursement depending on your plan. Keep those receipts (and keep reading for more tips), mama!
Do I Need a Prescription to Get a Breast Pump Through Insurance?
Your insurance provider may require you to have a prescription from your doctor or you may have to show proof that you’re receiving maternity care.
Typically, insurance companies need to see the physician’s national provider identifier (NPI) number and a diagnosis code (for pregnancy). Ask your physician or midwife for additional assistance.
Which Questions Should I Ask My Insurance Company?
Do you cover hospital-grade rental, personal double electric pumps, or both? Your insurance may only cover hospital-grade pumps through rental. Be sure to ask how long you’ll be able to rent a pump, if applicable. Some moms only need a pump to establish nursing, while others need a long-term set-up. If you don’t require a hospital-grade pump, be sure to ask what other types are available.
Do you cover manual or electric pumps or both? While manual pumps are lighter and easily portable, double electric pumps are more effective. They’re the perfect choice for moms who need to pump daily.
Which brands or models of breast pumps do you cover? Some insurance companies only cover pumps from specific brands or certain models of pumps.
Are additional equipment parts covered? To pump, you’ll need flanges, tubing, bottles and other storage supplies that may or may not come with your pump.
What dollar amount will you cover? Electric pumps tend to be more expensive than manual pumps and high-tech pumps with a ton of features can cost you several hundred dollars. Your insurer might have a coverage cap, so ask before you purchase.
Do I need to hit a deductible first? If your insurance allows for out-of-network, you may need to meet your deductible before your provider will cover the cost of your pump.
Do I need to order through a medical supply company you work with, or can I buy a retail model and submit the receipt for reimbursement? Some insurers will allow you to purchase the pump of your choice and then reimburse you. Some insurers have a durable medical equipment (DME) company they work with that you’ll need to get your pump from for complete coverage.
Which DMEs do you work with? If you’re required to purchase a pump from a DME, ask which ones they work with. Your insurance company may also take care of this step for you—just be sure to explain the type of pump you’re looking for first.
When can I get my pump? While some providers will allow you to order your pump as soon as you find out you’re pregnant, others may make you wait until 30 days before your due date.
What Happens if Your Pump isn't Covered?
If your insurance does not include free breast pump coverage, chances are you have a "grandfathered" plan. According to the ACA, insurance must cover breast pumps at no cost to breastfeeding mothers. Plans that were created before 2010, when the ACA was enacted, are considered to be grandfathered. If your request is denied, under the ACA you have the right to an appeal.
Is Willow Covered by Insurance?
Willow’s Insurance Coverage Tool can help you check your coverage in 24 hours. We partner with Healthy Baby Essentials to determine an estimate of what your insurance plan will cover for Willow. And, there’s zero obligation to purchase after checking your coverage.
Important Note: For Willow pump reimbursement, you may need the following codes:
Pump Tube A4281
Milk Bags K1005
Using an FSA/HSA to Purchase Your Willow Pump
You can also use an FSA/HSA to pay for your Willow pump. All you have to do is pay for your breast pump,milk bags and accessories using your FSA/HSA debit card.
To learn more about insurance or our payment options and available discounts, reach out to our team or visit our Help Center.