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Breast Pump Supply Issues Result in Changes
February 15, 2013
Due to a low supply of breast pumps across the industry, we are making some changes to how we work with our breast pump suppliers to meet the needs of our members. These changes apply to both breast pump rental and purchases.
Under the health reform law, breast pumps are available without cost-share under many plans as part of the expanded list of women’s preventive care services. To receive a breast pump without cost-share, members may call the number on the back of their ID card for network breast pump suppliers or obtain a breast pump through their network doctor.
Because the industry anticipates the supply issues to continue for several months, we’re taking the following steps to help improve the chances that women who are lactating and have delivered their baby receive breast pumps as quickly as possible:
- Members are asked to order their breast pump near their due date or after they have delivered their babies.
- Breast pump suppliers may ask members for their doctor’s contact information, the date the baby was delivered or their due date, and whether breast milk is currently being produced by the mother. The breast pump supplier may verify this and other information with the member’s doctor before the breast pump is shipped.
- Women whose due dates are weeks or months out will be asked to call again closer to their due date or after they have given birth.
Even with breast pump supply issues, normal lactating women should still be able to get a breast pump within a reasonable time frame. It is important to know that the best way for many women to establish breast-feeding during the first weeks postpartum is to feed her infant from the breast directly and that pumping breast milk is useful to help continue breast-feeding thereafter.
Members are not required to obtain prescriptions for breast pumps prior to calling a breast pump supplier. Members will not be reimbursed for breast pumps purchased at retail stores.
The approved national breast pump suppliers continue to ship the breast pump directly to the member, and the network doctor or breast pump supplier bills UnitedHealthcare directly for reimbursement.
Out-of-network breast pump coverage
As with other preventive care services, if a member’s plan covers out-of-network preventive care, then a breast pump received from an out-of-network doctor or supplier would also be covered and cost-sharing may apply. An out-of-network supplier is a DME supplier, not a retail store. Under the health reform law, only breast pumps received from a network provider or supplier are covered at 100 percent.
If a plan does not cover out-of-network preventive services, then out-of-network preventive services (including breast pumps rented or purchased out of network) will not be covered.
For more information on breast-feeding support under the health reform law, review:Snapshot: Women's Preventive Care Services: Breast-feeding Support, Supplies & Counseling or visit the United for Reform Resource Center at uhc.com/reform.
Jan. 1, 2015 PDL Updates
Updates will take place on UnitedHealthcare’s Advantage and Traditional Prescription Drug Lists (PDLs), the the SignatureValue Formulary, and OptumRx direct business on Jan. 1, 2015. Learn more
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