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NewMrsG
Love my GiGi
Member since 12/11 1442 total posts
Name:
Mrs. G
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NYC teachers & breast pump coverage (UPDATED)
If you have GHI make sure you call to check! I found out that it is covered. I had read on here previously that it wasn't with the NYC GHI plan that a lot of teachers have. I work in a charter school in NYC, and all I need is a script from the OB, and they will authorize to see what exactly is covered, and I have to pay a $100 ded...which is better than the full price of the pump.
Ok just got an update for you girls.....
One of the providers that I was told was covered is called Better Living Now. I had started the claim for the pump and they just called me this morning and I was told that an electric pump was not covered...on the hospital grade breast pump (which I am assuming is electrical anyway...not really sure.  ) but only if the baby was in the NICU for some reason. It was some specific code on the plan.
However the woman did NOT agree with this at all...and said she was calling back the insurance to fight it since it was going to be a state mandate and it should be covered. So she will call back once she does. So I will keep you posted on the outcome.
I don't know why GHI did not tell me that when I first called and just told me yes it was covered. So shady. 
Final Update.....
So I got another call back last week and I can not try to apply until the baby is born, and they are still going with if it is only medically necessary. So even with the new law this is still the case. 
Message edited 1/2/2013 7:48:12 PM.
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Posted 12/10/12 7:16 PM  |
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SLPlady1984
She's here!
Member since 6/12 1207 total posts
Name:
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Re: NYC teachers & breast pump coverage
When i called ghi i was told only if it is deemed medically necessary. And when I asked what that mean I was told if the baby needed to stay in the hospital longer then me or if the baby has an issue where it can't latch
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| Posted 12/10/12 7:19 PM |
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NewMrsG
Love my GiGi
Member since 12/11 1442 total posts
Name:
Mrs. G
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Re: NYC teachers & breast pump coverage
Posted by SLPlady1984
When i called ghi i was told only if it is deemed medically necessary. And when I asked what that mean I was told if the baby needed to stay in the hospital longer then me or if the baby has an issue where it can't latch
Do you have a PPO? I think depending on if it is a PPO or not the coverage is different. I called two days ago...and they gave me 2 different providers that would do it.
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| Posted 12/10/12 7:27 PM |
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SLPlady1984
She's here!
Member since 6/12 1207 total posts
Name:
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Re: NYC teachers & breast pump coverage
It's whatever ghi the city gives with blue cross hospital
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| Posted 12/10/12 7:54 PM |
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NewMrsG
Love my GiGi
Member since 12/11 1442 total posts
Name:
Mrs. G
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Re: NYC teachers & breast pump coverage
Posted by SLPlady1984
It's whatever ghi the city gives with blue cross hospital
Yea that's what I have as well. Hmmm odd. They put me on hold a few times to make sure saying the city plan was weird with it. When did you last call?
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| Posted 12/10/12 8:28 PM |
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MESal0820
LIF Adolescent
Member since 2/11 543 total posts
Name:
Meghan
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Re: NYC teachers & breast pump coverage
My husband is NYPD, we have GHI with BCBS hospital. Is it the same plan?
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| Posted 12/10/12 10:36 PM |
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cateyemm
Twins!
Member since 7/10 8027 total posts
Name:
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Re: NYC teachers & breast pump coverage
There's been new legislation mandating pumps to be covered by all ins cos. Its starts on your anniversary date. For ghi, the op is correct.
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| Posted 12/10/12 10:52 PM |
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Ellynrose
LIF Adult
Member since 10/11 1714 total posts
Name:
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NYC teachers & breast pump coverage
I'm going to have to check this out. I was hearing after January 1st companies were covering pumps due to obamacare. Then again I could be wrong lol
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| Posted 12/10/12 11:16 PM |
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mommyago
♥ Lucas and Layla
Member since 8/08 2979 total posts
Name:
Jenise
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Re: NYC teachers & breast pump coverage
yeahhhh this makes me so happy!
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| Posted 12/11/12 6:10 AM |
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NewMrsG
Love my GiGi
Member since 12/11 1442 total posts
Name:
Mrs. G
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Re: NYC teachers & breast pump coverage
Posted by MESal0820
My husband is NYPD, we have GHI with BCBS hospital. Is it the same plan?
Same thing I have. My husband who is a DOT worker has the same as well
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| Posted 12/11/12 6:24 AM |
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SLPlady1984
She's here!
Member since 6/12 1207 total posts
Name:
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Re: NYC teachers & breast pump coverage
I called last week...Thursday I think and it is covered if you can prove medical necessity
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| Posted 12/11/12 7:32 AM |
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NewMrsG
Love my GiGi
Member since 12/11 1442 total posts
Name:
Mrs. G
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Re: NYC teachers & breast pump coverage
Posted by SLPlady1984
I called last week...Thursday I think and it is covered if you can prove medical necessity
Weird we got different info. Maybe there is a slight difference in the plan. I am getting a script today so will find out soon if it gets authorized or not
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| Posted 12/11/12 10:00 AM |
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NYCGirl80
I love my kiddies!
Member since 5/11 10413 total posts
Name:
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Re: NYC teachers & breast pump coverage
As other posters have said, EVERYONE with insurance will now be covered for breast pumps when your insurance renews (usually Jan 1) due to the Obamacare legislation. If you call now, your insurance company will give you the old information. Call after Jan 1 and you'll get the proper info.
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| Posted 12/11/12 12:03 PM |
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NewMrsG
Love my GiGi
Member since 12/11 1442 total posts
Name:
Mrs. G
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Re: NYC teachers & breast pump coverage
Posted by NYCGirl80
As other posters have said, EVERYONE with insurance will now be covered for breast pumps when your insurance renews (usually Jan 1) due to the Obamacare legislation. If you call now, your insurance company will give you the old information. Call after Jan 1 and you'll get the proper info.
Yea maybe they gave me updated info. Except they didn't mention I had to wait until Jan 1st to be covered...they just said once they received the script.
But if you are getting different info as a NYC teacher maybe try after Jan 1 or call now and ask about coverage after Jan 1
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| Posted 12/11/12 12:07 PM |
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Beachgirl59
LIF Infant
Member since 5/12 296 total posts
Name:
K
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Re: NYC teachers & breast pump coverage
MY husband is NYPD also and I called a few weeks ago to ask and they told me no it was not covered? I'm not a huge fan of this insurance...I feel like whenever I call they are just so rude.
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| Posted 12/11/12 2:15 PM |
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NewMrsG
Love my GiGi
Member since 12/11 1442 total posts
Name:
Mrs. G
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Re: NYC teachers & breast pump coverage
Posted by Beachgirl59
MY husband is NYPD also and I called a few weeks ago to ask and they told me no it was not covered? I'm not a huge fan of this insurance...I feel like whenever I call they are just so rude.
Odd maybe there are slight differences between some of the plans.
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| Posted 12/11/12 3:24 PM |
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Beachgirl59
LIF Infant
Member since 5/12 296 total posts
Name:
K
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Re: NYC teachers & breast pump coverage
I just checked and I have PPO also. I'm going to call again and ask.
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| Posted 12/11/12 3:29 PM |
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NYCGirl80
I love my kiddies!
Member since 5/11 10413 total posts
Name:
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Re: NYC teachers & breast pump coverage
Posted by Beachgirl59
MY husband is NYPD also and I called a few weeks ago to ask and they told me no it was not covered? I'm not a huge fan of this insurance...I feel like whenever I call they are just so rude.
Likely it is not covered now. But it has to be covered after the new year. You won't need a breast pump on day 1 so you can inquire about this as soon as Jan 2 rolls around.
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| Posted 12/11/12 3:54 PM |
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Beachgirl59
LIF Infant
Member since 5/12 296 total posts
Name:
K
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Re: NYC teachers & breast pump coverage
Posted by NYCGirl80
Posted by Beachgirl59
MY husband is NYPD also and I called a few weeks ago to ask and they told me no it was not covered? I'm not a huge fan of this insurance...I feel like whenever I call they are just so rude.
Likely it is not covered now. But it has to be covered after the new year. You won't need a breast pump on day 1 so you can inquire about this as soon as Jan 2 rolls around.
Not unless I deliver early..
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| Posted 12/11/12 4:15 PM |
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classc1
LIF Adolescent
Member since 6/10 805 total posts
Name:
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NYC teachers & breast pump coverage
Thanks for this post. Hubby is a NYC teacher and we have GHI with Empire/ BCBS. I too read that as of 1/1/13 it must be covered under the new healthcare law. I also read that they now will cover certain lactation services and consultations.
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| Posted 12/11/12 9:49 PM |
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NewMrsG
Love my GiGi
Member since 12/11 1442 total posts
Name:
Mrs. G
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NYC teachers & breast pump coverage
bump for update
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| Posted 12/14/12 8:48 AM |
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cateyemm
Twins!
Member since 7/10 8027 total posts
Name:
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Re: NYC teachers & breast pump coverage (UPDATED)
My doc faxed the script to better living now and I'm waiting for them to deliver it. Not sure if you have to wait for baby to be born or not. It's a state mandate and ftr they told me its a hospital grade rental.
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| Posted 12/14/12 9:47 AM |
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NewMrsG
Love my GiGi
Member since 12/11 1442 total posts
Name:
Mrs. G
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Re: NYC teachers & breast pump coverage (UPDATED)
Posted by cateyemm
My doc faxed the script to better living now and I'm waiting for them to deliver it. Not sure if you have to wait for baby to be born or not. It's a state mandate and ftr they told me its a hospital grade rental.
This is why she was gunna try to fight it since it was a mandate. I started the authorization process before the script was sent. Then got the phone call. She told me to hold onto the script until she calls back. If yours goes through keep me updated.
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| Posted 12/14/12 9:50 AM |
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Novemberbaby
LIF Infant
Member since 8/12 133 total posts
Name:
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Re: NYC teachers & breast pump coverage (UPDATED)
When I called GHI I was told NYC employees were not covered under the new law. They are grandfather into not having to cover this new law.
Message edited 1/2/2013 3:22:31 PM.
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| Posted 1/2/13 3:11 PM |
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NewMrsG
Love my GiGi
Member since 12/11 1442 total posts
Name:
Mrs. G
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Re: NYC teachers & breast pump coverage (UPDATED)
Posted by Novemberbaby
When I called GHI I was told NYC employees were not covered under the new law. They are grandfather into not having to cover this new law.
''
Just did another update.
But it's not covered unless it is medically necessary....like if the baby has to be in NICU or you have twins, or there is something else going on.
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| Posted 1/2/13 7:49 PM |
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