Getting the cost of your breast pump covered by your insurance company.

Getting the cost of your breast pump covered by your insurance company.

Medela Free Style Pump. We all look this glamorous while pumping, no?

Did you know that some hospitals consider breast milk “medically necessary” for your premature or medically compromised kiddos therefore requiring you to purchase a breast pump?

Did you know that that nursing mothers of multiples often get the full cost of their breast pump covered by their insurance company?

Here are a few things you need to do if you think you might qualify to get your breast pump covered.

-Call/Read your policy: Read through your policy or call the insurance company before you EVEN have your multiples. While you’re on the phone, ask if your coverage will include a visit from a lactation consultant as well. Some policies have one (or more) visit(s) built in to every delivery.

-Check your insurance company’s rules.: What are the conditions which need to be present in order to get the pump covered. Do you need prior authorization before buying the pump? Will there be a co-pay? Do you need to meet a deducible first?

-What exactly is covered?: Will your insurance cover the entire cost of the pump? Will they only cover a rental? Are you limited to brand or type? What is the maximum amount they will cover? With pumps costing upwards of $300 will they cover the WHOLE amount WITH accessories?

When submitting  your claim, you will often need a medical code to include. Occasionally the desk in the nursery, or NICU, will have a pre-formatted letter for you to submit. Put asking about this on your “ToDo” list while still in the hospital or inquire about it if/when you take your hospital tour.

If you are submitting the form yourself, here is a list of common medical codes which may help you get your pump covered.

Getting the cost of your breast pump covered by your insurance company.

Make sure you fill out the proper form!

  • Child Cleft palate/lip749
  • Abnormal tongue position750.1
  • Down’s syndrome758
  • Neonatal candida infection771.7
  • Breastmilk jaundice774.39
  • Other transitory neonatal775.5
  • Feeding problems in newborn779.3
  • Abnormal loss of weight783.2
  • Feeding difficulty – infant783.3
  • Failure to thrive784.4
  • Dysphagia787.2
  • Suck reflex abnormal796.1
  • Mother Twin pregnancy post-partum condition or complication651.04
  • Abscess of nipple675.03
  • Infections of nipple675.04
  • Abscess of breast675.1
  • Nonpurulent mastitis675.2
  • Other specified infection of breast and nipple675.8
  • Unspecified infection of the breast and nipple675.9
  • Retracted nipple676
  • Cracked nipple676.1
  • Engorgement of breasts676.2
  • Other and unspecified disorder of breast676.3
  • Suppressed lactation676.5
  • Other disorders of lactation676.8
  • Unspecified disorder of lactation676.9
  • Dermatitis contact692

Good luck! We hope you have great success in getting your breast pump covered.