Karen, I have two suggestions about replying to this letter.

First, instead of replying to the form-letter generating office that sent it,
get on the telephone to the special department that is in charge of
mother-infant health.   Almost every insurance co has a program to make sure
mothers get prenatal care etc -- they do this because they know that
investing money in this saves them money in the long term, and so there is
usually some actual human being -- often a CNM or similar -- running it and
empowered to make exceptions to various rules under it.   Sticking with
customer service will just get you a runaround.

Second, AND ONLY AFTER THE INSURANCE CO EMPLOYEE YOU ARE TALKING TO IS AN
HCP, do NOT address the criteria in the letter.  Obviously it is true, after
all, that a breast pump can be used outside of illness.   Instead, speak to
the real point, which is that if they don't authorize the charge the baby
will be sicker -- which of course they don't want! -- and they will have
comcomitantly higher costs from the babies care.   So EVEN THOUGH the pump
flunks their test they should decide to WAIVE IT IN because it is both the
baby's and THEIR OWN interest to do so.

Again, if you make this argument to the drone who answers the telephone you
will get nowhere but once you get a doc or a nurse on the line, which you can
do with persistence, they will almost certainly approve it.  And by pushing
them to do so you help set a precedent for the next family.

Elisheva Urbas
who has done her share of pushing insurance companies into granting waivers.

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