I just got off the phone with my insurance company and was informed that my coverage doesn't include a breast pump because my employer opted out of covering it. Does this sound legit? Would anyone know if an employer can pick and choose what the insurance will or will not cover? I am so disappointed and am wondering if I should call the insurance company back to see if I get the same answer from a different rep.
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I would call back. My understanding is that they have to cover *something*, but it might just be a simple single manual pump. I had a really annoying, long phone call with my insurance back in January trying to find out and I gave up. I'm going to call again when it gets closer to my due date and hope they have worked out all the kinks in the system by then.
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I think they need to cover something also... But they could cheap out like my employer and only cover the manual pump
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@3littlebees: I actually went through this same thing recently - I even called our insurance company twice and got the same answer - no coverage, employer opted out. However, then my husband called the insurance coordinator at his work (we are insured through him) and got a completely different answer. No, the company had in fact NOT opted out and a breast pump WAS entirely covered by our plan! She even went as far for me as getting all the information from our insurance company on how to go about getting a pump and will be backing us up if the insurance company gives us trouble.
So, I would suggest talking to your insurance coordinator just to get a sure answer. I think companies can opt out, but I also think insurance companies are still getting up to speed (putting it nicely) on the whole breast pump coverage thing. Frustrating, for sure!! -
@kiddosc: DH's insurance only covers the manual pump!
I was bummed but DH reminded me that we have no copays for prenatal care and we won't have to pay for most of our hospital stay.
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My insurance has a case manager for pregnant women and she is who I finally got the correct information from - you might want to check if your insurance company has a program like that.
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I would call again. The only way I know of that employers can get around this rule is if their plan is more than a certain number of years old and they've been grandfathered. For example, DH works at a university & I work at a school district. Both our group plans have been in existence for many years so neither one offers the coverage. If either plan ends up with any changes in the future (different co-pays or out of pocket cost changes for example) then they would have to comply with the breast pump coverage.
I don't think a simple "opt out" is a legit reason.
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Thank you ladies for all your replies...I now have a little bit of hope :). I will definitely put in another call to the insurance company as well as speak to the insurance coordinator. Thanks again!
ETA: this board is so wonderful. Without the help of your replies, I would've just accepted what the insurance rep told me today.
I was bummed but DH reminded me that we have no copays for prenatal care and we won't have to pay for most of our hospital stay.
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