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Why a Prescription Is Needed for Purchasing a Breast Pump through Insurance

Why a Prescription Is Needed for a Breast Pump

The Affordable Care Act includes a provision for breastfeeding, supplies, support and services to be paid without cost sharing to members.  So, what does this mean for you?  Well, depending on your insurance plan, the effective date of that plan and your insurance carrier, it can mean a brand new double electric breast pump free of charge from a top manufacturer such as Medela, Hygeia or Ameda.   Other plans may provide for a rental of a hospital grade pump or possibly a manual breast pump.

Different insurance carriers vary, and so far The Affordable Care Act seems to be open for interpretation, depending on the plan you have. That’s why here at Aeroflow Healthcare, we have a dedicated team of specialists who help mothers navigate the confusing world of insurance and breast pump coverage.  What you may not know is that some insurance carriers require the baby to be born before they will pay for the breast pump, while others will allow for shipment of breast pumps prior to due date.

Once our team has helped you determine coverage and you are ready to move forward with the pump, what is the next step?  Well, we must get a prescription from your physician. Why is a prescription needed for a breast pump to be covered through health insurance when you can purchase one off the shelf at many retailers?  The answer is that in order for most insurance to cover equipment (including breast pumps), they require the equipment to be deemed medically necessary.  So, by obtaining a prescription from your physician, you will be able to show the insurance company that your physician has determined that the breast pump is, in fact, medically necessary.

Feel free to give us a call where an Aeroflow specialist can work on your behalf to obtain the prescription from your physician and ensure the prescription includes all elements required for correct processing and proper payment by your insurance company.

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