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Return to: Finding the Perfect Breast Pump

Will My Health Insurance Coverage Pay For My Breast Pump?

Many insurance companies will cover the cost of a breast pump. If you are interested in purchasing a breast pump and plan to be reimbursed by your insurance company, you should follow a few guidelines before selecting and purchasing a pump.

1. Find out if your insurance coverage will cover the cost of a breast pump.
2. Does medical necessity need to be determined for the coverage to apply?
3. Is prior authorization required? If so, what are the steps in the process?
4. Does the coverage cover a purchase or a rental? Is there only a specific brand that is covered?
5. What is the maximum benefit? Does a deductible have to be met first? Will there be a copay?
6. Is a time or dollar limit set? 

 

Is your pump medically necessary?

In order for your breast pump to be covered by your health insurance plan, you will need to prove that the pump is medically necessary for you and/or your baby. Your pump may be considered medically necessary if you are in one of the following situations:

-Your baby is premature or sick.
-Your baby is intolerant of formula.
-Your baby has trouble nursing correctly.
-You gave birth to twins, triplets or other multiples.
-You will work outside of the home.
-You will be physically separated from your baby for extended periods.
-You are experiencing medical problems that prevent you from breastfeeding.

 

ICD-9 Codes Related to Breastfeeding 

Your doctor uses ICD-9 Codes when communicating your diagnosis to the insurance company. Being able to identify which ICD-9 Code matches your situation can help when proving that your pump is medically necessary. 

 

Diagnosis   Code

Mother

Twin pregnancy post-partum condition or complication 651.04
Abscess of nipple 675.03
Infections of nipple 675.04
Abscess of breast 675.1
Nonpurulent mastitis 675.2
Other specified infection of breast and nipple 675.8
Unspecified infection of the breast and nipple 675.9
Retracted nipple 676
Cracked nipple 676.1
Engorgement of breasts 676.2
Other and unspecified disorder of breast 676.3
Suppressed lactation 676.5
Other disorders of lactation 676.8
Unspecified disorder of lactation 676.9
Dermatitis contact 692

 

Child

Cleft palate/lip 749
Abnormal tongue position 750.1
Down’s syndrome 758
Neonatal candida infection 771.7
Breastmilk jaundice 774.39
Other transitory neonatal 775.5
Feeding problems in newborn 779.3
Abnormal loss of weight 783.2
Feeding difficulty – infant 783.3
Failure to thrive 784.4
Dysphagia 787.2
Suck reflex abnormal 796.1

 

Things to Remember When Filing Your Claim

Review your policy before you begin to ensure that you know what benefits are included with your plan’s coverage. 

Call your insurance agency before you purchase a pump. By contacting your insurance company first, you can find out the right process for being reimbursed otherwise you may end up paying for the pump yourself. 

Promptly file your claim. Most insurance companies generally set a filing time limit of one year from the date of service. Filing after this time frame could cause your claim not to be considered. 

After purchasing your pump from BreastPumps.com, we’ll help you with the reimbursement claim filing process. Our step-by-step Insurance Claim Guide will ensure that you submit a thorough claim for your reimbursement request.  

When you purchase your breast pump from BreastPumps.com, we can help you with your reimbursement claim with your health insurance company. Find the right breast pump for your needs by reading Breast Pump Reviews and by looking at our Breast Pump Comparisons

Return to: Finding the Perfect Breast Pump