Fight may be nearing the end. Heard today that they are granting an "exception" and the associate who called took down the information for the one local "In-Network" provider who could order the pump I wanted but was not willing to order, just a single unit, plus that names of two OON providers that have the pump available or could get it.
She indicated that the worse case scenario is allowing me to purchase the pump at a Babies-R-Us and having to override their system to reimburse me.
We shall see.
I wish all the other mom's out there luck with this battle. Stick to your guns and get the benefits you deserve!
Some of the responses have truly been helpful and insightful and for that I THANK THOSE MOMS. Other responses... all I can say is: Wow!
Thanks to the ACA, this is supposed to be covered by insurance as preventative care. This is now a federal mandate and not something that I am outrageously assuming I am entitled too. You, and every nursing mother, are as well - one pump per 12 month period per child. This is now a right. If you did not check with your insurance company and obtain your benefit, then I am truly sorry for your lost. Per the company policy, which I pay for with every paycheck, preventative care is covered at 100%. I am not trying to obtain anything that I am not supposed to be getting.
Remember: I am /not/ being told that I cannot get that pump. I /not/ being told that they will only pay up to a certain value. I am being told I need to find an In-Network medical device supplier (whom in theory would therefore accept BCBS) and carries the pump. Simple request. Simple answers.
The tones of distain and attitudes of just "sucking it up" are exactly the reasons why a fight like this is occuring for me now. Instead of demanding what is ours, some are willing to be rolled over by the system. For shame.
Seriously?
Either get an approved O. in network or pay for what you want.
Not to be harsh, but 70% off is always a pretty good sale.
I wasa breastfeeding mom that had to work in a professional office as well, and no breast pump was covered for me - I was at the client site and didn't even have a nursing room....my boss would leave her office several times per day so I could have privacy and not have to do it in the bathroom.
Your problem is that you may have to pay 30%? Aren't even the good ones no more than $500? I got mine from Target for about $80 and it worked fine....so a professional one can't be thousands. Worst case is you spend $150 (assuming a $500 cost) and get the one you WANT.
Insurance is right, you NEED one that will extract milk...not a designer one.
I am having a hard time understanding how you can claim you NEED this STYLE of pump so badly if you are not willing to pay 30% of the cost. You don't like the one that is covered 100% because of aesthetics, I hope to god aesthetics will never be considered a need.
I suggest that the pump you want is more expensive thus is not kept in stock by preferred providers. Have you asked if they could order it for you?
I suspect that the reason that the reason you can't get the pump you want has more to do with cost than provider. BC has placed a limit on how much they're willing to pay. Insurance companies have to control ccosts or our premiums will be even higher.
Btw what does your situation have to do with affordible care? You're still paying your for your own care through your purchase of insurance at market value not regulated by government. Even with affordable care we still will not be able to pick what we want. There will be limits. Someone still has to pay.
After your SWH sounds like you're saying it's your right to have the pump of your choice when the law says it's your right to have a pump. I don't understand your thinking.
Also, who do you think actually pays for your pump? You do with your premiums. If you expect insurance to pay for your choice then you also need to. Expect premiums to go up for everyone. Insurance is a business; not a charity.
Bottom line. Is fighting this while increasing your stress. And decreasing the joy of having a baby worth it?
Unfortunately you aren't going to get the expensive pump that you want so it's really up to you to decide if you are going to go out of network and get what you want or choose from something available from an in network provider.
I never considered expecting insurance to pay, nor did any of my friends. So I would just pay the 30% and be grateful.
Your HR will have to handle this, or you can petition it. Chances you, you are paying the 30%.
My homebirths were preference too. Since we have a really high deductible, I ended up just paying cash.
Sorry, I'm with Suz on this one. If the pump you want is covered 70%, I'd go for that, and be grateful for that coverage. :)
Otherwise, if it's the packaging you hate on the others that are fully covered, just get a bag you like to replace the manufacturer's carry bag. I hated the Medela PIS bag and used a clean bag that I liked instead.
No help in an answer for your insurance company issue, but I wonder since you have to travel for your job, could you see if your company might pay for the remaining 30%? If you don't go ahead and order it, you could be fighting this for months without a pump...
You might call the customer service line at the Medela company and ask them if there are any suppliers that accept BCBS for their products. They may be able to help you. Many of the medical device companies can provide that service. Even coverage at 70% might be end up being acceptable to you to get the pump you want. Good luck!
What pumps does Edge Park carry? Perhaps someone here could help you figure out which would be most similar to your preferred pump and would best meet your needs.
Perhaps some of the confusion is that you seem so absolutely dead-set on a pump with a particular bag, and that's not a medical requirement.
i spent 150$ on an Ameda double pump that is both plug in and runs on batteries, and it super small and easy to use. I just used a soft cooler as my bag. and the nice thing about it too is the playtex bottles fit the suction part so when i was pumping heavy i had a 20oz bottle to catch it all, instead of having to stop and change bottles.
sounds like a really nice fancy pump.
how awesome that your insurance company is willing to pick up 70% of its cost!
maybe your employer will kick in for the rest?
but if not- wow, you get a kickass pump and only have to shell out 30%!
khairete
S.
