To contract with insurance for direct billing, you need a DME license.  That is incredibly consuming of paperwork:  you have to have a MD order for the pump with a diagnosis and retain the orders for 7 years.  There are issues for non-reimbursement, gray areas where pump need vs want may leave insurance not covering, the cost of retaining records has to be included in your price, etc.  For this reason, most hospitals do not do DME stuff.  Rent the pump to the mom at a lower price and let her do the leg work to get reimbursed by giving her a proper receipt for the rental.   I know many "supply houses" that have given up pump rentals because of the low return and reimbursement and some that have used various types of "working mom" pumps to fulfill their contract because they don't have to be returned.  One of the issues with this was the lack of responsibility of clients to return.  They thought their insurance was "paying for" the pump and they could just keep it - similar to the way insurances often pay outright for nebulizers rather than rent them from a supply house.  To me, this will be a problem with the ACA as it demands insurance to pay for "supplies" where is the limit and delineation between medically necessary and desirable?  What quality is "sufficient" to satisfy?  Who will be required to bear the expense of purchasing the "supplies" and going after the companies for reimbursement?  IN my area, many WIC offices have lost pumps over the years to clients who don't return them.  This may not be common elsewhere but occurs quite regularly in this area. 



-----Original Message-----

From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Mandy Schaub

Sent: Wednesday, July 11, 2012 7:29 AM

Subject: Billing Private Insurance



Can anyone clarify if a hospital has to carry a DME liscense to bill insurance for pumps?  I know you have to be a DME to bill Medicaid and Medicare, but I've heard you do not have to have a DME to bill private insuance.  Any proof of that statement out there?  I've been looking and can't find it.  Come August 1 United Healthcare will be covering purchase or rental of breastpumps to ALL their members.  I do have a document that says that.



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