Monday, April 29, 2013

What is an ACA (Affordable Care Act) Breast Pump?

All of the dust has settled and now we all, healthcare professionals and families, are asking,

"What is this affordable care act stuff and what is my coverage?"

For Women's preventative services the Affordable Care Act (ACA) covers multiple items. The article found at ACA coverage  sums everything up nicely and summarizes your coverage as a breastfeeding mom with "Breastfeeding support, supplies, and counseling: Pregnant and postpartum women have access to comprehensive lactation support and counseling from trained providers, as well as breastfeeding equipment. Breastfeeding is one of the most effective preventive measures mothers can take to protect their health and that of their children. One of the barriers for breastfeeding is the cost of purchasing or renting breast pumps and nursing related supplies." 

So, how do you take advantage of this? It really is an easy process.

1. Get your insurance card out. Look on the back and call the customer service number. Give them your ID and other information they request and ask: "What is my coverage for a personal ELECTRIC pump? "

2. The next questions is: "Where can I get this pump from?" The insurance company should be able to give you list of providers or DME offices they are working with.

3. The pump you receive will be a special ACA pump. It will more than likely come in a brown box with the company name on it- Medela, Ameda, Hygeia - and should contain a personal electric pump with a pump kit for your personal use.

Now I have my pump, but what if I need follow up with breastfeeding challenges?

Again, this is covered under ACA. To find out your coverage follow these steps.

1. Get your insurance card out. Look on the back and call the customer service number. Give them your ID and other information they request and ask: "What is my coverage for lactation consultation with an IBCLC?"

2. Find out what your coverage is specifically: Is it prior to deductible, after deductible? Is it different in network vs out of network? What is your copay amount? How many visits do you have at this rate?

3. The next questions is: "Who do you have as listed Lactation Consultants that I may see?" The insurance company should be able to give you list of providers and their direct contact information as well as their websites. These providers have been credentialed by the insurance company and carry an NPI so they may bill insurance.

4. Make sure to do your homework! Just because a provider is listed doesn't mean they are the best available. Like many do for other healthcare professionals be diligent. Check YELP, Yahoo, etc.  for reviews and go to the providers website if provided. References should be available in one or both of these locations. You can also check the providers licensure status at the IBCLE site at IBCLC registry


Other hints to help you navigate this process:

1. DO this work prior to delivery. KNOW your benefits before the pump or consult is needed. It is always easier to deal with this preventatively rather than reactively.

2. CALL your hospital and find out who their IBCLC is and how long they typically spend with a patient in L&D and on Postapartum. If the answer is 15 min or less and that their hours are Mon-Fri 8-5 then make contact with your insurance company's IBCLC ahead of time. When the time comes you will be glad that all you needed to do was let them know you have delivered and could they come and guide you through to your successful path.

3. DON'T be afraid to ask questions. ACA has included coverage for breastfeeding moms for a reason. The AAP as well as the Surgeon General as well as your government are making this a priority and they want you  to do the same.

Best wishes and if you are in the Las Vegas area and need guidance please feel free to look us up at http://Breastfeeding and Babies, Yeah!  .

-Lisa Weinshenker, RN, IBCLC

1 comment:

  1. This is a really good site post, i am delighted I came across it. I will be back down the track to check out other posts that
    breastfeeding cookies

    ReplyDelete