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Questions to Ask Your Private Insurance Company

Does my insurance plan cover Women’s Preventive Services under the Affordable Care Act?

If YES:

I am expecting in month/year, or, I gave birth on month/day/year.

What breast pump(s) does my plan cover?

  • Do I need an order (prescription) from my doctor?
  • Is there a time frame (how soon before birth or how long after birth) for when I may obtain a pump)?
  • Is MilkWorks (Tax ID #470835579) in network for breast pumps?
  • If out of network, is there any DME (Durable Medical Equipment) or preventive coverage for a pump obtained at MilkWorks?
  • Do I have coverage for an E0603 Personal Use Pump (Diagnosis Code Z39.1)?
  • If yes, how often may I obtain a Personal Use Pump under my insurance coverage (e.g. one per pregnancy, one per lifetime, one every 3-5 years)?
  • Do I have coverage for an E0604 Medical Need (Hospital Grade) Rental Pump?
  • Do I need pre-authorization for coverage of an E0604 Medical Need Rental Pump?
  • Are there any conditions or restrictions for coverage of an E0604 Medical Need (Hospital Grade) Rental Pump?

Does my plan cover breastfeeding consultations by an IBCLC (International Board Certified Lactation Consultant)?

  • If yes, are there any restrictions (i.e. # of visits allowed)?
  • If you know the name of the MilkWorks IBCLC you are scheduled to see, you may ask if they are in network. Otherwise, ask if any of the following MilkWorks providers are in network with your plan. All of our providers are in network with the same plans: Dr. Kathryn Leeper, Debra Erikson, Teresa Flattery, Suzanne Meyers, Anne Easterday, Meghan Gerken, Kaye Lidolph, Jennifer Maestas, Christina Schill, Ann Seacrest, Melinda Tockey

If my provider is out of network, does my plan cover lactation services for out of network providers differently?

Are breastfeeding classes covered?

(Procedure Codes for classes include 99412 or S9443 using Diagnosis Code Z39.1.)

Are there any other benefits or restrictions related to breastfeeding support under my plan?

If NO:

I am expecting in month/year, or, I gave birth on month/day/year.

Do I have benefits under my medical DME (durable medical equipment) coverage for a breast pump?

  • Is this coverage subject to any deductibles or coinsurance?
  • Are there other details I need to know about my coverage?