Why We Need Health Care Reform, Part 2

December 7, 2009

Continuing the discussion of wacky health insurance…

When I was in the hospital after giving birth to Burrito and Tamale, I had a hospital-grade breast pump in my room. After I was discharged, there was a pump in their suite in the NICU for my exclusive use. But, I knew that I’d need my own pump when the babies went home. The twin books instructed me to check with the insurance company because they often cover pump rental for preemies.

Here is what we learned when we called, after over half an hour of being shuttled around to different people in the phone tree.

  • The pump is covered for babies born prior to 32 weeks. Burrito and Tamale were born at 33w4d, no good.
  • The pump is covered for babies with a documented feeding problem such as use of an NG tube. They qualified based on this criterion, if we were to get a letter from the neonatologist.
  • If we were approved for the pump, it would be covered for two months of rental.
  • There is a deductible of $120.

The hospital charges $68 per month for the pump rental. Doing the math, this meant that after we’d gone to the trouble of getting a letter from the neonatologist and filing the insurance claim, insurance might cover $16 of the $136 rental fee for the first two months, then nothing after that. Or, they might reject the claim.

It was not worth our time to file the claim for the (not guaranteed) possibility of that $16. I’m sure that’s exactly what the insurance company had in mind.

$16. Maybe.

6 Responses to “Why We Need Health Care Reform, Part 2”

  1. a Says:

    Aargh! That is incredibly frustrating! I don’t even know what to say to that – other than I’d file the paperwork and get my freakin $16. Then I’d do my best to eat as much fatty food as I could, so they would have to pay for my bypass surgery sometime in the future to make all those premiums worthwhile.

  2. Michele Says:

    That sucks. Our insurance covered our hospital grade pump at home, which was great. The rental would have been $50/month if we hadnt had coverage. I’m sorry that yours is such a pain in the ass. đŸ˜¦

  3. Carrie Says:

    AWFUL! They would not cover ours either, and we often wondered aloud why they would not encourage MOMs to breastfeed, or at least try, given the known health benefits? Even for a few weeks? C’mon…

    So nice to hear from you so often- don’t know how you do it! I have had a blog post 1/10 written for a week and 25 unanswered emails. MUST use hands-free pumping contraption, yes?

  4. Ana Says:

    Oh my god that’s so annoying. I’m glad you posted about this though, because I can pass this info along to a friend preggo with twins—she was really counting on the insurance covering the pump, I will tell her to call & find out the details first.

  5. Cat Says:

    Our insurance company first told us the pump would be covered while the babies were in the NICU but then kept rejecting the claim each month until my husband called to remind them they said they’d cover it. Guess they were just hoping we’d pay it because the bill showed up here.

    I can’t imagine working for an insurance company and only telling people “no” all day long.

  6. Shinejil Says:

    RIDICULOUS!!! [tearing at hair and rolling eyes like a mad bull]

    Pumps should be covered for all preemies and/or documented cases of lactation challenges (poor latch, etc). With the evidence so strongly in favor of breast milk, esp for preemies and small or ill babies, this is actually a way to save money on future complications or illnesses. The morons.

    We had no expectations that the pump I rented for a month would be covered. But if I hadn’t gotten the encouragement to rent it, I would never have been able to establish my supply. Moreover, if we hadn’t had the good sense to ask for donor milk for the two days until my milk came in (thanks to the pump), our tiny baby would have lost precious ounces he couldn’t afford to lose. None of this was covered, though it certainly impacted our dude’s health.

    Again, I must scream, “IDIOTS!”

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