There are many benefits to breastfeeding your new baby, but it’s not always easy to get started. Here are some important questions and answers about how we can help you make the most of your health plan during this exciting time.
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Supporting you on your breastfeeding journey
Most hospital maternity units have lactation consultants on staff. While you’re in the hospital after delivery, ask to have the lactation consultant come to see you while you are breastfeeding. She can offer suggestions and encouragement to make breastfeeding the special experience it should be.
All members are covered for lactation consultant visits at home or in the doctor’s office after delivery. A lactation consultant must be an International Board Certified Lactation Consultant (IBCLC)® who is also a nurse, midwife, physician assistant, nurse practitioner, or physician. For more information about lactation consultant visits, call the Healthy Futures program at 888-447-0337 (TTY: 711). Our hours are 9 a.m. to 5 p.m., Monday through Friday. A care manager will be happy to help you.
There are many reasons that you may need to use a breast pump to help feed your baby. The Affordable Care Act requires most health insurance plans to cover the cost of a breast pump as part of women’s preventive health services. To help you successfully breastfeed, EmblemHealth has made breast pumps available to you through participating vendors.
This benefit does not apply to members enrolled in limited benefits coverage plans. If you have a question about your benefits, call us at the number on the back of your member ID card. A Customer Service representative will be happy to help.
- Call us at the number on the back of your member ID card to go over your coverage options.
- Get a prescription from your doctor or other provider during the third trimester of your pregnancy. This can include a midwife, nurse practitioner, or physician assistant.
- Contact one of our durable medical equipment (DME) vendors below. They can help you arrange to mail, fax, or email your prescription. The DME vendor will arrange to deliver your pump to you.
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Better Living Now |
800-854-5729 |
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Yummy Mummy |
855-879-8669 |
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A Personal Touch Boutique |
631-266-2865 |
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You can keep your manual or electric breast pump. All necessary supplies for double pumping such as bottles, caps, tubing, and shields are covered and should be included in the breast pump kit. You are only eligible for one breast pump per 12-month period.
If your baby is in the neonatal intensive care unit (NICU), is unable to latch, or has a medical issue, you may need a hospital-grade breast pump. Your doctor can give you a prescription to rent a hospital-grade breast pump.
You will need to get a preauthorization to rent a hospital-grade breast pump. The rental is effective for 90 days. If you need to continue renting the breast pump for longer than 90 days, you may need another preauthorization and prescription.
- Your provider will need to provide a prescription stating the specific reason that the hospital-grade breast pump rental is a medical necessity.
- Call us using the number on the back of your member ID card and we can help you request prior authorization for the rental of your hospital-grade breast pump. You will need to submit the prescription of medical necessity from your provider, so make sure you get that first.
- Contact a participating vendor from the list above to rent your pump.
- The DME vendor, after receiving permission, will arrange to deliver your pump and supply the breast pump kit to you.
- All necessary basic breast pump supplies for double pumping, as well as receptacle bottles with flanges, caps, and tubing, are included in the breast pump kit with the rental.
Breast pump supplies purchased through an EmblemHealth DME vendor listed above will be reimbursed with proof of purchase/receipt only; no prescription is required for breast pump supplies for participating plans.
Exclusions: Breast pump adaptors and battery packs, regular baby bottles not specific to the breast pump, travel bags, breast pump cleaning supplies, hands-free bras, baby weigh scales, ice packs/coolers, nursing bras, breast shells, nursing pads, nipple shields, and over-the-counter breastfeeding creams or ointments.
A prescription is required for reimbursement for all covered plan members who have purchased either an (E0602) Breast Pump: Manual, any type; or an (E0603) Breast Pump: Electric (AC and/or DC) through our DME vendors. Reimbursement may be requested in writing with proof of purchase/receipt and a prescription from your provider. If you have questions, call the Healthy Futures program at 888-447-0337 (TTY: 711). Our hours are 9 a.m. to 5 p.m., Monday through Friday. A care manager will be happy to help you.
Benefit exclusions
Note: This benefit does not apply to members enrolled in limited benefits coverage plans, such as dental only and vision only, or grandfathered plans, such as certain Healthy New York plans and certain standard HMO individual direct payment plans. Also, City Vytra members are not covered under the Women’s Preventive Services (WPS) mandate. For more information regarding grandfathered plans and the WPS, please visit healthcare.gov/coverage/breast-feeding-benefits/. Medicare does not cover breast pumps or breast pump supplies.
