Every insurance company is different and has varying guidelines for coverage of certain benefits. Per the Affordable Care Act, insurance policies should cover breastfeeding equipment and supplies as preventative benefits, meaning they should come at little to no cost to patients.
While some states have found loopholes to extend their timeframe to become compliant, most companies provide these benefits to new or expecting moms. Fortunately, UMR insurance guidelines for breast pumps are compliant with the Affordable Care Act.
UMR is a “third-party administrator” (TPA) who your employer hires to ensure your claims are paid correctly, which keeps health care costs low for you and your family. UMR is not a health insurance company — they are a part of United Health Care (UHC).
Per UHC guidelines, when breast pumps are covered, they are not to be shipped prior to 30 days before the birth of the child. Unfortunately, UHC does not cover the costs of hospital grade breast pumps (unless specifically authorized prior to dispersion), nor do they cover accessories, such as bags, batteries, cooler totes, etc.
Since UHC also acts as an MCO (managed care organization) for some Medicaid policies, not all policies follow the rules above. These Medicaid policies are still subject to following Medicaid guidelines, which typically state a patient must have a prescription prior to obtaining a pump, and that the baby must also be born.
Healthcare companies do not cover breast pumps by brand — they cover them by code. Most standard and double electric breast pumps are coded the same, and are therefore covered at the same rate — this can also be different for Medicaid policies, due to the prices paid for the pumps by the distributor versus the prices reimbursed by the state.
Qualify for your pump today!
To find out if you qualify under the UMR insurance guidelines for breast pumps and at what rate, you can fill out our simple three-step Qualify Through Insurance form. A Breastpump Specialist will contact your insurance company, verify your benefits and network status, and contact you within 1-2 business days with your options.
Just because your insurance company will not allow you to obtain the pump more than 30 days prior to birth does not mean you should wait to complete the form! A Specialist can set a follow-up date with you, and get everything set up now.
If you are not covered for a pump, or you want accessories, Aeroflow Breastpumps carries a wide variety of breastfeeding supplies and equipment at competitive pricing. Check out our online store to find exactly what you're looking for.
If you need immediate assistance or have additional questions about the UMR insurance guidelines for breast pumps give us a call at 844-867-9890. An Aeroflow Breastpump Specialist will be happy to take your information over the phone and get you on your way to get your free breast pump delivered to your front door. We look forward to working with you!