You may have heard that per the Health Care Reform Act, breast pumps, breast feeding supplies, and education are now a covered benefit through your health insurance company, and are often covered at little to no cost to the patient. But why, if insurance covers a breast pump, should you still have to pay an upgrade fee for certain items?
One of the most popular pumps on the market is the Medela Freestyle. This is an amazing set- the motor is lightweight, you get a cooler, tote, hands-free accessory set, rechargeable lithium ion battery, and the best part is- it can be covered by your insurance company! What a lot of people do not realize, however, is that your insurance company will only cover the items that are medically necessary to express the milk (the pump motor, tubing, two breast shields and two milk storage containers). This is where an “upgrade fee” would come into play.
Companies, such as Aeroflow Breastpumps (who offers pumps at amazingly competitive pricing, see here) have to pay for these items before they can sell (and yes, even though your insurance company is paying for the item, it is still a sale), to you. They pay for the items not covered by insurance companies- like the battery, hands-free accessory set, bags, cooler, etc and since there are no billable codes or diagnosis codes to make these items medically necessary, your insurance company does not reimburse the distributor (IE- Aeroflow Breastpumps) enough to compensate for the price they paid to provide the item to you; this is where “upgrade fees” stem from.
“What is my insurance company says they pay up to $500.00? The retail price for the Medela Freestyle is right around $400.00. This is enough to compensate”- this is a commonly heard question. Your insurance company may allow up to $500.00 for a breast pump, but will only pay a company their ‘contracted rate’ which means they will pay the rate agreed upon when the contract to do business was signed between your insurance company, and the distributor you are dealing with.
If you are curious as to whether or not you are covered for a breast pump through insurance, you can find out by simply completing our Qualify Through Insurance form . Your Breastpump Specialist will contact your insurance company, get your benefit information and network status, obtain your prescription from your physician, and contact you within 3-5 business days with your options.
Your dedicated Specialist can also advise as to what upgrade options you may be interested in based on your needs and wants. Let Aeroflow Breastpumps help you make your breastfeeding journey a breeze. Qualify for your pump today!