Consumer Investigation: Not all insurers pay for breast pumps



PITTSBURGH - A new policy is supposed to make easier for women to breastfeed their newborns, but it's not working as well as some mothers would like, Consumer Reporter Robin Taylor found.

A provision in the Affordable Care Act requires health insurers to pay for equipment like breast pumps, but the law doesn't spell out exactly what insurers have to pay for, and that's left wiggle-room for insurance companies to pay the minimum.

Katy Rank Lev is one of the lucky ones. She ordered her breast pump from a medical supply company. The next day, it was delivered to her door, and her insurer, UPMC, paid for everything.

"I can't imagine not having this kind of a breast pump to express milk for my son while I'm at work," said Lev.

But some insurers are covering the cost of manual breast pumps only, rather than electric ones that are much more efficient and more expensive.

"Having only a manual pump would be an insurmountable challenge to expressing milk at work," said Lev.

A lactation consultant at Magee Women's Hospital showed me the differences among three types of pumps.

"This is a Medela hand pump. It's just for one breast, and the mother just squeezes for about 10 to 15 minutes," said Anna Heh, registered nurse.

Hand pumps cost about $50, while the most popular Medela double electric model retails for about $350.

"This is top of the line. This is a hospital-grade electric," said Heh.

Hospital-grade units are rented for $75 per month, usually to mothers with premature babies or to those who are having trouble breastfeeding. Most insurers will cover the cost when medically necessary.

But insurers may not cover the kind electric pump most moms need to go back to work.

"They come in and expect they're going to get top of the line and that's not always the case, and then they're disappointed," said Karen Ewin, RN, a nurse practitioner at Magee Hospital.

Working women, like Lev, think insurers should pick up the tab, so babies like her son Felix can be breastfed for at least a year.

"It's so important to me to be able to give him my milk that my body is making for him," said Lev.

Health care advocates want the government to clarify the law, so women are able to get what works best for them.

I checked with the big insurers in Pittsburgh. Both UPMC and Highmark cover electric pumps under most policies.

Some insurance policies are grandfathered in, so they don't have to cover breast pumps under the Affordable Care Act.

If you're expecting, check with your insurer before you buy anything. If you're covered, you may have to buy a pump through a medical supply company.

If you're not covered, you should still be able to deduct the cost from your flexible spending account.