In a message dated 97-01-14 01:19:56 EST, you write:

>Hasanyone else had any experience dealing with insurance companies and
rental
>pumps?  Please help me.  TIA

Sorry for the delay in this reply, not reading my lactnet posts regularly

With insurance and HMO vs PPO, budget constraints ad infinitum,  a few
thoughts are:
 1. Go ahead and get the pump before her milk IS compromised and argue later
 2. If the family can't afford a rental, try to find a station that does
grant pumps for      special circustances or get a relative  or group of
friends to chip in.
 3.Is she eligible for WIC?
 4. As far as the ins co goes, start with the personnel benefits office to
see if their poicy includes "Durable Medical Equipment"  Hospital grade pumps
are considered DME just like a nebulizer for asthmatics.  If this family or
the company has purchased a policy that doesn't cover this type of benefit,
there's nothing you can do.  If DME is covred, you need the codes.  For
example, the diagnosis code for Failed Weight Gain is 783.4, wt loss 783.2
(these codes come from the pediatrician)  The code for "misc" equipment
(pumps) is E1399, and supplies (kits, SNS, etc) is A9270.  I have had some
success with this.  Your best ally is a supportive peds office crew.  They
can often get "authorization" for things when an "outsider" can't and they
have all the codes!!.
5.  If these are strong parents, they can "bug the heck" out of their
insurance company by continually resubmitting a claim.  By the time the claim
has been rejected ttwo or three times, the claim will be routed higher up the
supervisory chain.  I had one mom start with a medical need, keep the pump
for 7 months of pumping at work and actually get reimbursed for the whole
thing by arguing with the insurance co. supervisor !!
6. Often a family will say they can't afford a pump when in reality they can.
 Sometimes we have to help them justify the initial expenditure.  A rental
pump is cheaper than ABM for a YEAR, not to mention the reduced cost of a
shorter hospitalization.
7. We have a unique opportunity to educate the people within the Insurance
companies who actually  make decisions by providing education on the value of
breastmilk... especially for hospitalized infants.  Where's Alison
Hazelbaker??? Do we still have a group working on 3rd party reimbursement??
Liz Flight, RN, CLE, IBCLC