Saturday, August 11, 2012

Dear Obamacare,

There are a lot of things people say about politics on both sides.  I really, really try to stay out of the whole discussion typically, because even in my 'wise' old years of the late twenties, I've learned that people are going to believe what they want to believe, and that is their prerogative.  Nothing is going to change that no matter how much you argue about it.

However, there is one thing I will say when something directly affects me and my family because of something a politician has done, in a good way.

I say thank you.

I recently heard that as of a week or two ago, things that were previously not covered for women's reproductive and sexual health are now being taken a bit more seriously and being covered.  As a pregnant woman, I heard some interesting rumors, and I called my insurance company to confirm.  Turns out, there are a TON of things covered for this pregnancy that were not covered during my last pregnancy.  I'll delve into those in just a moment.

Last time around, I had heard rumors of some insurance companies covering breast pumps.  I called our insurance at that time and was told no, it did not, at least in full.  I was told that my insurance may pay a portion of a manual pump.  However, as I have carpal tunnel, it makes pumping manually- while not impossible- generally a bit more difficult. I also returned to work on the weekends after two months at home with little man and then during the weekdays as well part time after three months maternity leave.  A manual pump did not cut it to get me in and out of the pump room (or office, or storage room, or yes, I've even pumped in a bathroom) in the time/space I was given to do so.  As a working mama, it just took too much time.  So, we took the hit of buying a $260 electric, dual breast pump out of pocket, not to mention bottles, tubing, adapters, etc.

This time?  It will be completely different.  Based on what my insurance representative told me, here is what would be covered:

(I've added some of the more technical information as it interests me, because I work with insurance and billing for my career as a SLP, hope it helps!)

- Breastfeeding and counseling support: a total of three visits are covered, whether they be as an inpatient, outpatient (at a lactation consultant's office), at your doctor's office (if they have a LC), or in  your home.  Be sure that they are coded as 99401-99404 with the modifier TH using the diagnosis code VQ4.1

- Breast pump: a manual OR electric rental pump is covered for 10 months of rentals, at which point the representative told me I would own that pump.  (So, they call it a rental, but if you rent it long enough and/or are still breastfeeding after 10 months, you can keep it.)  For this, you'll need to use the codes for an E0602 or E0603 rental.  I was told that to be 100% covered with no co-pay, I'd need to use a PPO provider that is in-network.  The representative gave me 5 different companies (home medical equipment or hospital based women's boutiques) that I may use.  I'd check with your insurance to find out where you can get your pump. What makes me REALLY happy about this one, is that if it is a rental pump, it is MUCH higher quality than many of the pumps commercially available to mothers nowadays.  In my humble opinion, most ANY pump that is a single-user model has flaws, as that means it is not hygienic for other users, which says to me there is milk transfer into the pump.  To me, that implies old milk in the pump... um, yep.  That's pretty nasty.  Which is not something I want to mess with, especially seeing as it is something I used with little man for over a year.    Again, if you are using a RENTAL pump, even if it eventually becomes yours, that HAS to be a multi-user product, which means it is more hygenic for both you and your baby.

- Breast pump supplies: I was told by the representative that they also cover tubing, adapter replacements, locking rings, polycarbonate bottles, and caps for those bottles.  When I asked how many they would cover of each, the rep had to put me on hold and ask her supervisor, but when she returned I was told that it was unlimited based on medical need.  She said that I could have my Ob write a letter that since I'd be returning to work 10 hour shifts, I would need three sets of bottles/caps (6 bottles and 6 caps) per work day to be able to adequately pump, and that they would cover that.  It also sounded like they would replace any bottles, caps, tubing or adapters later on as needed so long as I had a note of medical need from my Ob.

I am completely shocked at how awesome this is.  This takes the cost of breastfeeding/pumping down by leaps and bounds and puts it in reach for so many more women than could afford it previously.  It is a landmark for our government to actually care for mothers in such a way, and from the bottom of my heart, I am so very thankful.

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2 comments:

  1. It is so awesome for Moms. Also? Workplaces are now required to provide Moms with a private place to pump other than the bathroom. Moving up in the world, we are ;)

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  2. Melissa- Do you have a link on that? Two of my workplaces have a separate pump room that is pretty sweet, however, one company I work for has no pumping accommodations whatsoever and I've pumped in a bathroom, in an office where the door didn't shut all the way & I had to back my chair up against it, or in empty patient rooms with no locks on those doors either. I'd love to have literature as to what they need to provide, so that it doesn't just look like I'm coming up with it out of nowhere.

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