Are You Getting The Best Breast Pump From Your DME for Your ACA Benefit?

By now, most moms-to-be are aware of the breast pump entitlement guaranteed through the Affordable Care Act.  No longer registering for Medela Pump in Styles through baby shower registries at big box stores like Walmart and Target, today’s pregnant women are seeking DMEs (Durable Medical Equipment vendors –think of the companies that supply home medical equipment such as crutches, commodes, oxygen, etc.) to source their insurance breast pumps.

Breast Pump Box

Free breast pumps for all!  Great news, right?   Well, hold on a second.  While gone are the expensive baby shower registries and the slick retail packages loaded with bells and whistles, gone also are the many consumer-friendly components of the free market, namely: competition, choice and transparency of cost.  With the retail market dead, only those with poor insurance benefits or the well-off looking for a second or even third pump are shopping on Amazon these days.  The majority of women in the US are being directed by their insurance company to a “preferred in-network vendor” and coverage levels, included features and brand and model options are far from obvious.

Shopping around for a DME and seeking information regarding one’s benefit options and eligibility requires women to provide sensitive personal information prior to receiving product information.  Scary!  Without the ease of comparison shopping modeled on, many women are settling for the first DME that confirms their benefit eligibility.  And sadly, most of these DMEs operate on a “dump and run” basis.  That is, they provide a pump and sometimes offer in-home or in-hospital delivery options with little or no product support.

This means that some women are receiving a pump that is ill-suited for their situation (eg. A personal grade pump rather than a hospital grade pump when baby is in the NICU) with little to no qualified lactation support for explaining the technology and supporting the mother through her feeding challenges.  The administration of breastfeeding technology without hands-on support is associated with shorter duration of breastfeeding.   I don’t think this is what policy makers had in mind when they wrote the legislation.

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As IBCLCs in private practice, we at Lactation Care have made the following observations in the post-ACA-enactment environment:

  • Many moms are utilizing pumps that aren’t suitable for their situation, often with detrimental effects on their milk supply.
  • Quite often moms are not being fully-informed about their benefit options either in terms of vendor options or pump brands, models, or grades and are settling for “whatever they gave at the hospital.”  Many moms actually have no idea which vendor supplied their pump.
  • Some insurers that previously offered a multiple-user, hospital-grade pump as a benefit to their subscribers based on medical necessity no longer do so.  In other words, insurers are offering a cookie-cutter approach to managed healthcare.   In order to cover the cost of covering a pump for all, they have cut back on the benefit for those who need it most.   The impact of this policy is most harmful to the most fragile infants who would receive the greatest benefit from receiving mother’s milk.
  • Many moms have no idea that accessories exist that might make their pumping experience more comfortable (e.g. Flanges that come in various sizes, just like nipples!) or where they could source these items locally, as few DMEs stock accessories.
  • Many moms don’t know who to turn to for questions on product support, maintenance and troubleshooting.   Customer service is left in the hands of the pump manufacturer rather than a trained local resource.
  • The pumps and services offered by DMEs vary tremendously and it’s worth shopping around for your vendor and not leave it in the hands of the breast pump fairy at the hospital where you deliver.

free breast pump insurance claim

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