Screen Shot 2013-11-21 at 2.29.13 PMIf you weren’t paying attention in the last few months and years, the Affordable Care Act (ACA, Obamacare) has rolled out . . . and it includes a special benefit for new moms: a free breast pump.

Before you get too excited, though, there are “a few, uh, provisos. Ah, a couple of quid pro quos,” as the Genie in Aladdin would say. The biggest catch: the ACA doesn’t specify which pump you get. Not even what kind (manual, mini electric, dual electric, rental). But, you say, you’d like a top of the line Medela or Ameda personal use pump? Well, the answer is: maybe yes, maybe no.

Turns out insurance companies (and some state insurance rules) determine what pump you can get. And in most cases, you also won’t be able to stop by your favorite retailer to purchase your pump. Why? Many insurance companies require customers to purchase pumps from the company’s designated durable medical equipment company (DME). These DME’s distribute medical equipment (like oxygen bottles and nebulizers).

Yep, that means you’ll have to track down one of your insurance company’s DME’s and then call to see what pumps they might have in stock. Parents have noted in a number of other articles and blogs that they called their insurance providers’ designated DME’s and discovered they didn’t even have breast pumps available. Others noted that their provider only offers a manual pump–not very helpful if you plan to pump at work!

What if you want a more powerful pump like a hospital grade option? Again, this option may or may not be covered by your insurance. Some insurers will allow you to rent a hospital grade pump but only if you have a “medical necessity.” Translation: your doctor will have to fill out even more paperwork to “prescribe” a rental pump.

Bottom line in all this: you’ll need to talk to your insurance provider. Here are some questions to ask (source: Medela):

  1. What type of pump can I get? Do I have brand options (hospital grade rental pump, single or double electric personal pump, battery or manual pump)?
  2. Do I have to get the “recommended” pump or can I choose to purchase one (called “out-of-network”) and submit a receipt for reimbursement? If yes, what amount will I be reimbursed? Is there a dollar limit on coverage for breast pumps?
  3. If I have already obtained a breast pump, can I submit a claim for reimbursement?
  4. Do I have to get the breast pump approved first?
  5. When can I get my breast pump? Before giving birth? After the birth of my child(ren)?
  6. Where can I get my breast pump? Does it have to be from a designated place (aka “in-network” provider) or can I choose where to get it?
  7. Do I have a rental pump option? Do I need a prescription for proof of medical necessity?