The first step is understanding your coverage and benefits. Your insurance company (or your employer’s benefits department) can provide you with a policy handbook detailing the benefits of your plan.  After reviewing the policy handbook be sure to contact your health insurance plan’s member services department with questions.  Most insurance companies offer a toll-free customer service number that you can call with specific questions about your health plan.  (This number is typically found on the back of your insurance card.)  The insurance plan representative should be able to explain your insurance coverage for any of the products or services that you receive.

When calling your insurance company about your health insurance benefits and coverage, you may want to ask these questions:

• Does my insurance plan cover this breast pump (indicate type: hospital rental, purchased electric, battery or manual)? 
   
• Does my insurance cover services provided by a lactation consultant?
   
• Are there any restrictions? 
   
• Do I have to get the pump (or visits) approved first? 
   
• Are breast pumps covered only for certain medical reasons? If so, what are they?
   
• Is my lactation consultant/doctor’s office in the network?
   
• What will I need to pay? 
   
• Do I need to meet a deductible first?
  (A deductible is the amount of money that you could have to pay before your insurance pays for or reimburses you for any medical care or prescriptions.  Sometimes there are different deductibles for your family members, depending upon who is covered.  An individual deductible would need to be paid before that person gets reimbursed or has their medical care paid for by the insurance company. 
  
  If the whole family is covered under one family member’s insurance, then a family deductible is the amount of money that the family would have to pay first before the health insurance company would pay or reimburse for medical care or supplies).
   
• Is there a co-pay for the breast pump that I need or for the visits with the lactation consultant? 
   
• Is there a dollar limit on coverage for breast pumps?  Is there a limit on the number of visits with a lactation consultant?
  Sometimes the insurance company has set a limit on the amount of money that they will pay to cover your medical expenses.  For example, you may have coverage for a breast pump, regardless of type, up to $100.  Another example would be if your health plan covers only a specified number of visits to a lactation consultant.
  
  This is called a benefit cap or benefit limitation or maximum benefit. 
  Benefit caps or limits can be for different time periods as well: annual or lifetime. 
  An annual benefit cap or limitation is for one year.  It is important to ask your insurance company if you have an annual benefit cap and if so, what year do they use?  Do they go by the calendar year (January to December) or do they use a fiscal year or plan year (for example, from when your policy became effective—i.e., August 1 to July 31).
  
  A lifetime maximum benefit is the highest amount of money that your insurance will pay to cover you for healthcare expenses.  For example, you may have a $1million lifetime maximum benefit.  If your healthcare costs go over $1million, then you will not be reimbursed by that insurance plan for any portion of your medical expenses that exceed the $1 million limit.

Related Files

• Questions You Should Ask