The Patient Protection and Affordable Care Act
(often referred to as Obamacare or the Health Reform Act)
now, by law, requires private health insurance carriers to provide
breast pumps to pregnant and nursing mothers at no cost!
Limerick will help you with your insurance provider!
Limerick will help you with your insurance provider! Since the law is very new, many health insurance carriers are still working out the details of their breast pump coverage. Limerick Inc. is available to help you navigate the often complex health insurance process. Call us FIRST and we can help you get the breast pump and the support you need.
What exactly is covered?
The phrasing in the law is broad and that is why private insurance providers interpret it and its required coverage in different ways. In general, they are required to provide pregnant and nursing mothers with “breastfeeding support, supplies, and counseling.” The insurance providers are not permitted to charge a co-payment for any of the supplies or services they cover. They should also cover shipping for the approved supplies.
What is a DME?
DME (Durable Medical Equipment) for health insurance purposes is usually used in the context of a DME supplier or a DME manufacturer. The health insurance carrier will often negotiate a rate with a DME supplier to provide a breast pump, for instance, to their insured clients. Some insurance carriers will allow you to get your pump from a DME manufacturer as well, or directly from a hospital. If the PJ’s breast pump you want is not carried by your insurance carriers list of DMEs, you may have options. Call Limerick for assistance – we’re happy to help!
How do I get the breast pump that I want?
If you plan to do it on your own, the first thing you should do is contact your health insurance company to ask exactly what your specific plan will cover. But here’s where it can get complicated. Much will depend on your personal situation – such as when you gave birth, whether you are still in the hospital or at home, the baby’s health condition, your health condition, etc.—and your insurance provider. Different health insurance providers will have different requirements for payment or reimbursement—some will provide only the bare minimum equipment and support, and others provide quality equipment and robust support. You should be proactive about your personal situation and options, as there are rarely one-size-fits-all solutions. For instance, you may need a different type of breast pump than they generally provide, or you may need it sooner or faster than they normally send it out. You may want to buy your own breast pump and get it reimbursed. You may want to upgrade to a different breast pump with the difference in cost at your own expense. Many insurers are still developing their coverage policies or finding that their existing policy needs to evolve based on their insured clients’ needs. That’s where Limerick can help. Call us to explain your needs and our experts can help obtain the information you need to get the breast pump you want.
Why can’t I buy my own breast pump and just apply for reimbursement?
It’s best to find out in advance so you don’t get stuck with an out-of-pocket expense because you didn’t follow procedure. Some insurance companies will allow this, but others will require pre-approval, or a prescription from your doctor first. They may want you to purchase a brand of breast pump that you do not want, or you may be required to go through a DME (Durable Medical Equipment) supplier. And because this is a new provision for private health insurers, you should make your voice heard and let them know what your specific requests are. Various situations can arise after you give birth that may warrant a different, more specialized type of pump. Your doctor, the hospital, and/or a certified lactation consultant can help you sort through the various supplies that are available. Contact Limerick to help you understand the differences in pumps and lactation programs, and to help you navigate the health insurance process.
Let’s say you help me find out what kind of breast pump my insurance will provide. What if I want an upgrade or a different brand?
Certain medical circumstances may qualify you for a hospital-grade or more durable breast pump. You should be proactive in requesting the specific breast pump you desire, since health insurers are still shaping their breastfeeding coverage policies. If it is a cost issue, you may be able to pay the difference out of your own pocket, or using your Flexible Spending Account. Out-of-pocket expenses are also tax-deductible to the fullest extent allowed by law. Call us and we’ll guide you through the process:
Is Limerick Inc. a DME supplier?
Limerick Inc. is a DME manufacturer. Some health insurance providers will allow you to order directly through us, but many insurance providers are requiring covered breast pumps to come from their Durable Medical Equipment suppliers. Limerick Inc. produces PJ’s-brand breast pumps -- the PJ’s Comfort and the PJ’s Bliss. Both breast pumps have our patented technology which mimics a baby’s true suckling pattern. Please refer to these product pages on our website (www.limerickinc.com) as well as to the comparisons between the two products. If your health insurer’s DME suppliers do not carry Limerick breast pumps, contact us and we’ll do our best to help you get the breast pump you desire.
Why would I need a prescription for a pump?
Your particular medical breastfeeding needs may require a stronger, more durable breast pump that will help you produce more milk. Limerick PJ’s Comfort is considered hospital-grade. Limerick PJ’s Bliss is priced for retail. Both Limerick PJ’s Comfort and PJ’s Bliss are multi-user pumps. We have found that most insurers will cover the Limerick PJ’s Bliss, whereas the Limerick PJ’s Comfort will often be covered only if there are uncommon medical situations. Talk to your doctor and your health insurance provider to determine whether you need a prescription. Limerick Inc. is happy to help you in any way we can. Please don’t hesitate to contact us!