What can Obamacare do for me?

September 10, 2012 12:14 PM

I'm about two weeks away from the birth of my first child. I am emphatic about breastfeeding, but more importantly pumping breast milk for when I have to go back to work. Help me figure out the Affordable Health Care Act (crassly called Obamacare) and how I can get my hands on the necessary supplies and support that I'll need very, very soon.

This site makes mention of "comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum period, and costs for renting breastfeeding equipment ... in conjunction with child birth", but I have literally no idea how this will be implemented when I am at the hospital. My husband and I did a maternity tour over the weekend and were told about having lactation consultants and supplies available post-partum, but I was not thinking and did not ask how one goes about getting these things, specifically the breast pump and accompanying supplies themselves. The page I linked to above mentions that it is possible to rent, but I can find no further information about how to do that once I've got a baby in my arms.

Has anyone acquired a breast pump since the passage of the Affordable Health Care Act? Is there paperwork (there has to be paperwork, right?) Like I said, I am emphatic about breastfeeding and pumping and would love to not have to pay an arm and a leg for this if I don't have to. When I was on the maternity tour I mentioned earlier, they had the Rolls Royce of breast pumps, the Medela Freestyle, in one of the birthing suites, so I imagine that that is what will be offered at my hospital, if not something similar (although I'm hoping for Medela).

Extra info: I'm in Ohio, if that matters.

posted by ThaBombShelterSmith to health & fitness (20 answers total)

Call your health insurance company. If your policy has not renewed since August 1, they may not have implemented it yet.
posted by chiababe at 12:19 PM on September 10, 2012 [2 favorites]

Chiababe, forgot to mention that I recently switched my family insurance to my name, after August 1st.
posted by ThaBombShelterSmith at 12:22 PM on September 10, 2012

Call them up for sure and they'll either have a process to bill the hospital directly or you may have to submit a claim after paying out of pocket. You might also try calling the hospital's lactation consultant directly to discuss how they handle pump rental.
posted by chiababe at 12:24 PM on September 10, 2012 [4 favorites]

In hospitals around here, they send in a lactation consultant within a couple of hours after birth to check on how you're doing with the first couple feedings, and who does comprehensive patient education some time before you leave, and helps with things like pumps or nipple shields or whatever. It's billed by the hospital to insurance along with everything else; it was just itemized on my hospital "explanation of benefits" thingie with everything else and the insurer paid without dispute or complaint.

Beyond the hospital, licensed lactation consultants and places that rent pumps all bill your insurance, same as usual. It's just the same as acquiring any other medical service or equipment. (Anything you acquire directly, however, you probably have to fill out paperwork and be reimbursed.) In my area, all of this is done through a breastfeeding resource center sponsored at one of the hospitals, which is convenient for access and billing, but it certainly doesn't have to be.

Call the hospital and ask. It's really no big deal, it's just like any other medical service and works exactly the same for billing purposes.
posted by Eyebrows McGee at 12:25 PM on September 10, 2012 [3 favorites]

At least by us (Chicago) renting a pump was like $40 a month, so if you're planning to go the whole year it's probably cheaper just to buy it outright.

(or, uh, register for it)
posted by Oktober at 12:33 PM on September 10, 2012

Be aware that you might want a backup manual hand pump for yourself in addition to the fancy electric one. They are harder to use but they don't have to be charged -- and you may be surprised by all the unexpected emergency pumping scenarios you may encounter if you nurse for a good while.

Also be aware that the first pump you try may not be the best one for you, whether or not it's the "Rolls Royce" for other people. So ask the lactation consultant for advice if you're having trouble with a pump and feel you may need to switch. Some of my friends switched pumps three or four times. I was lucky enough to find a decent fit the first time.

In fact I used a hand pump alone when I was nursing, back in the bad old days before insurance would pay for such things. I got milk with the pump -- no problem there. My problem was that my son hated bottles passionately, and mostly refused to eat from them, letting all that precious milk I pumped go to waste. When he started losing weight, I wound up having to have someone bring him to my workplace so I nurse him on my breaks instead of eating myself, both of us perched precariously on an office chair in a dirty stockroom, me vainly trying to cover myself with a blanket that my child kept tearing off because he hated it, while my bosses clucked disapprovingly.

Ah, memories! You, however, are entitled to mandatory break time and a nice clean private place to pump, so make sure your bosses know it.

The ACA rocks.
posted by BlueJae at 12:49 PM on September 10, 2012 [3 favorites]

My last experience predates ACA but even several years ago my hospital had several lactation consultants on call who came by for a session the first day and were available to call as often as you needed while you stayed. They gave me all the contact information upon registration.
posted by dadici at 12:52 PM on September 10, 2012

In my case they provided sevral lactation consultant appointments post partum and a pump for free thru my insurance but ONLY because we were having problems. They surely would not have provided either for free for "no" reason had I just wanted them without an issue to solve. (after the hospital that is; I'm pretty sure I could have seen an LC for free while there after delivery).
posted by tristeza at 1:04 PM on September 10, 2012

I am due in about 5 weeks, and I called my health insurance company and asked them for information about breast pump benefits directly.
posted by amro at 1:04 PM on September 10, 2012

Have you tried contacting your local La Leche League chapter?

About a month before giving birth, I made an appointment with an independent lactation consultant to do a home visit the day after we got our Ravenous Beast home from the hospital. Her schedule was flexible enough that I could just call her when the baby was born to let her know we needed her then. Very glad I did this because the hospital lactation person never showed up. The baby nurses did help us out with the latch, though.

The private consultant brought a rental pump to our house.

I paid out of pocket for the pump and consultant, and will try to get reimbursed.
posted by yarly at 1:11 PM on September 10, 2012 [1 favorite]

Also, you won't need a pump right away probably - you can wait til two or three weeks, unless you have problems. Breastfeeding is so overwhelming at first that you don't need to make additional work for yourself. You can wait until your supply is established and you want to start the babe on an occasional bottle (3 or 4 weeks).
posted by yarly at 1:16 PM on September 10, 2012 [5 favorites]

You can also start keeping an eye out on Craiglist for free or very cheap pumps -- I ended up with a backup pump that way which was a lifesaver a couple of times because I kept my main pump at work, but got plugged ducts on weekends once or twice and needed to pump a lot to try and clear it. You just buy new tubing, flange assembly, and membranes.

Also you might want to be prepared for terrible in-house lactation consultants; not all hospitals have IBCLC LC's on staff and I found there is a world of difference between people who just call themselves LCs and people who have been internationally board certified as lactation consultants.
posted by rabbitrabbit at 1:27 PM on September 10, 2012 [1 favorite]

I would try calling the hospital and asking to speak with one of the lactation consultants. My mom used to be one and they had a whole program where high-end Medela breast pumps (that would normally cost and arm and a leg to rent/buy) were lent out to new moms and it was all covered by insurance/medicare. I don't know if anything like that is available in your area, but it is definitely worth it to call and ask. If you can't find a direct number for a LC online, try calling the labor and delivery unit and asking to be transferred.
posted by Mrs.Spiffy at 1:51 PM on September 10, 2012

My insurance covered a $200 Ameda pump (and would have covered the equivalent Medela pump - I opted for the Ameda because of the closed tube system) last fall. I just asked my provider for a prescription and had it filled at a pharmacy that handles durable medical equipment like this. Paperwork consisted of a prescription, an insurance card to show the pharmacy, a purchase agreement with the pharmacy (saying no returns and I'm responsible for whatever insurance doesn't cover) and a ~$10 copay at the pharmacy. I did this all before the babby was born.

We had a meeting with a lactation consultant in the first day or so after the birth. This was covered by insurance, and I think further meetings with that team would have been covered by insurance, but I never sought that out. For breastfeeding advice after that, I went to my doula and to a free support group offered by a different team of LCs.

I don't know how Obamacare changes any of this except guaranteeing more women access to these services. You should talk to your insurance provider to get details - odds are they'll cover most of the purchase cost of a Freestyle or Pump In Style or any similar product, and odds are you can get it now while you're still child-free. I don't know anything about renting, but you'll likely have similarly excellent insurance coverage for that.

If you want a Medela, get a Medela. You probably don't have to wait to be offered one. I had my choice of brands; the prescription was written very broadly.
posted by thirteenkiller at 2:27 PM on September 10, 2012

And like other people said, don't count on the hospital LCs to be a great resource. Some are and some aren't. Make sure you're aware of other BF support options in your community, if they exist.
posted by thirteenkiller at 2:31 PM on September 10, 2012 [2 favorites]

Not to rain on the parade, but just because your coverage started August 1 does not mean your plan year started August 1. Your first step should be reviewing your benefit information or contacting your health insurance company to find out when the plan year renewal date is. If it's prior to August 1, the ACA provisions won't be in effect yet. Changes are based on plan year, not individual members' effective dates.
posted by pecanpies at 2:38 PM on September 10, 2012

Also check with your local WIC office. Even if you don't want or qualify for the free food aspect, (in our experience) they will provide support or at a minimum be able to send you to the right place. We even have a quality pump on indefinite loan for free!
posted by attercoppe at 2:44 PM on September 10, 2012 [1 favorite]

nthing the suggestion to check out the local arm of the La Leche League, especially if you run into any problems and the hospital LCs can't help. Those women are amazing. And you don't have to join or go to meetings if you don't want to. They will help you on the phone.
posted by tuesdayschild at 2:55 PM on September 10, 2012 [1 favorite]

I found out after the fact that I could have gotten a breast pump for free with a prescription for one from my dr. as necessary medical equipment.

La Leche League rocks; get on their email group for the inevitable 3am freakout questions. Someone else will be up nursing at 3am too, it won't take long to get reassuring answers (and thereby more sleep!).

We found our lactation consultant by taking her class before the birth at the hospital. I was in hospital over the weekend, so no LC ever came to see me, and we did have some problems a day or so after we got home. INSIST that an LC come and see you at least once each day before you leave the hospital. So much easier than schlepping yourself and your tiny precious newborn out into the world.

Congratulations!
posted by vignettist at 11:04 PM on September 10, 2012

Another possible option for BF support is your pediatrician’s office. My pedi’s office had 2 lactation consultants on staff; the one I worked with was wonderful, and highly accessible to me.
posted by yawper at 6:31 AM on September 11, 2012