Breast milk storage bags are a necessary and recurring expense for parents who pump, providing a safe, pre-sterilized solution for collecting and preserving expressed milk. For a parent pumping multiple times a day, the cost of this supply can quickly become significant over the course of the breastfeeding journey. This guide provides a detailed walkthrough on how to leverage existing health insurance benefits to obtain these supplies at little to no out-of-pocket cost.
The Insurance Mandate for Breastfeeding Supplies
A federal health law requires most health insurance plans to cover preventative services, including comprehensive lactation support and equipment, without imposing cost-sharing measures like deductibles or co-payments. This mandate applies specifically to plans that are not “grandfathered,” meaning they were established or substantially changed after the law was enacted. Eligibility for this benefit is generally extended to all expectant and new parents covered under a compliant health plan.
This coverage requirement includes certain breastfeeding supplies, with breast milk storage bags now widely recognized as a covered item under preventative care guidelines. The benefit is designed to remove financial barriers to necessary equipment for those who are pregnant or are currently lactating.
Step-by-Step Guide to Ordering Through a DME Supplier
The process for obtaining covered breast milk storage bags begins with securing a prescription from a healthcare provider, such as an obstetrician, midwife, or pediatrician. While the bags are a preventative supply, insurance companies often require a written order, sometimes called a Letter of Medical Necessity, to justify the expense and quantity. This document must include the parent’s information, the expected duration of the need, and the specific item: breast milk storage bags.
Once the prescription is obtained, the next step involves identifying an in-network Durable Medical Equipment (DME) supplier or a specialized third-party vendor contracted by the insurance plan. These suppliers manage the ordering, billing, and direct shipment of medical supplies, including lactation equipment. Parents should contact their insurance company directly via the member services number to request a list of approved DME providers for breastfeeding supplies.
Many parents find it easiest to work with a vendor specializing in lactation supplies, as these companies will often verify coverage and obtain the necessary prescription directly from the healthcare provider on the patient’s behalf. After selecting a vendor, the parent will complete an eligibility form on the supplier’s website, providing insurance and provider information. The chosen DME supplier will then submit the prescription and necessary billing codes, such as A4287 for disposable storage bags, to the insurer for approval. Upon benefit verification and approval, the supplier ships the first order of storage bags directly to the parent’s address.
Understanding Quantity Limits and Brand Restrictions
While coverage is typically provided at no cost, it is subject to specific administrative limitations imposed by the insurance plan and the DME supplier. Most insurance plans manage this benefit by setting a maximum quantity of bags that can be ordered within a defined period. A common allowance falls within the range of 90 to 120 storage bags per calendar month, or often a larger supply provided in three-month increments.
These quantity limits are intended to cover the average need for a regularly pumping parent and are a form of medical management used by the insurer. Additionally, the DME supplier’s contract with the insurance company dictates the specific brands and types of bags available. The parent’s choice is usually limited to the brands the supplier carries, which may include popular options like Medela, Spectra, or Motif. Parents should track their usage and the date of their last order to ensure they time their resupply request correctly.
Troubleshooting Denials and Coverage Alternatives
Despite the federal mandate, some parents encounter denials, particularly if their health plan is one of the few that is “grandfathered” or is a self-funded plan exempt from the preventative services requirement. If a denial occurs, the first course of action is to contact the insurance company’s member services department to understand the reason for the rejection. If the denial is based on a lack of medical necessity documentation, the healthcare provider may need to submit a more detailed Letter of Medical Necessity to support the claim.
If the insurance plan is confirmed to be exempt from the mandate, or if the appeal process is unsuccessful, viable alternatives exist for purchasing supplies with pre-tax funds. Breast milk storage bags are classified as a qualified medical expense by the Internal Revenue Service. This makes them eligible for purchase using a Flexible Spending Account (FSA) or a Health Savings Account (HSA). Utilizing an FSA or HSA allows parents to pay for the recurring cost of storage bags with tax-advantaged dollars, providing substantial savings.