Most mothers who choose to breastfeed will find that a breast pump is essential to meeting their breastfeeding goals, mostly because they often need to return to work.
Under the Affordable Care Act, breastfeeding support, supplies and counseling are a covered benefit at no cost-sharing to the patient. Some grandfathered health plans may not cover these benefits. Here is how you access these benefits:
Do I need a pump before I give birth? No. Hospitals will provide you with any lactation aids necessary to help you breastfeed including a breast pump. Plus you have hands! Learn hand expression!
How do I get a breast pump: Your OB provider can write a prescription or referral verifying your medical need for a breast pump. Not all insurance plans require a prescription. Your health plan will tell you which durable medical equipment or (DME) company to call to see what pumps they offer.
When to order a breast pump? Some health plans allow you to order a breast pump before you deliver and some do not. You need to contact your health plan to find out their policy. It’s important for you to know this information before you come to the hospital, in the event you need a pump at discharge. Call when you are 28 weeks pregnant!
What type of breast pump? The type of breast pump you need will depend on how frequently you will need to pump. There are three types of breast pumps:
|Type||How frequent will I be pumping?||HCPCS Code||Used for|
|Manual||1-2 times per day||E0602||Engorgement
Short separations of 2-3 hours
|Personal Use Electric||Daily use 3-4x per day||E0603||Temporary separations 5+ hours
Increase milk supply
Return to work or school
|Hospital Grade or Multi User||Replaces every feeding 8+x a day||E0604||Medical necessity
How do I know which type of pump I need? When breastfeeding is going well, many mothers do well with a manual or personal use electric breast pump. You will need a high quality personal use electric breast pump (E0603), if separated daily from your baby for more than 6 hours for work and school. Before you choose a breast pump, we suggest attending a breastfeeding class, discussing it with your provider and/or contacting BabyLiveAdvice’s lactation consultants for help choosing the right pump for your situation. Make an appointment now at www.babyliveadvice.com.
What is a HCPCS? This is the code your OB provider must put on the referral/prescription to clarify the type of pump they are prescribing.
Are “hospital-grade” pumps better? The term “hospital-grade” is a marketing claim. In some cases, like when you are fully separated from your premature baby, a multi-user heavy duty breast pump may be absolutely necessary. Health plan policies make them difficult to access. There are several Personal Use breast pumps that are very effective, but sometimes come at a higher cost.
How do I know if the pump I am getting is going to work? There has been a flood of new, cheap breast pumps that have not been reviewed or tested for whether they will work to bring in your milk or remove it efficiently or painlessly. Here are some guidelines for choosing a breast pump:
- Double Electric so you can pump both breasts at the same time
- Vacuum of -250mmGh
- 2 modes – massage and expression
- Electric cord, not just battery operated
- 2 sizes of flanges with options to purchase other sizes
What if the DME provider charges more than the insurance covered rate for a higher quality pump? Recently, Health Plan policies have lowered the reimbursement rates for E0603 Personal Use electric breast pumps. Because the rates are so low, some DME providers will not provide an appropriate high quality pump without the patient paying an “upgrade” cost. These costs can range from $30-100. Whether this is legal or not is unclear. Unfortunately, there hasn’t been a challenge to these practices.
What other accessories might I need? Getting a good flange fit is critical for good milk removal. Here is a good video on flange fitting and measuring. Most quality breast pumps will come standard with 2 flange sizes (24mm and 27/8mm.) However not all people have the same size nipples as the flanges provided and may need to be smaller or larger to get comfort and good milk removal. It’s important to know the pump brand you choose can also provide you with a selection of flanges. Unfortunately, the health plan DME provider may not cover these costs. Some other accessories that are helpful:
- Ice packs
- Breast milk bags
- Extra parts, like tubing, flanges, bottles, valves and membranes,
- Car charger adapter
- Pump bag
Once you have your breast pump, make an appointment with one of BabyLiveAdvice’s lactation consultants so you can learn how to express your milk efficiently and painlessly!