When Tricare posted their new breast pump and lactation support policy to their website last Friday and I wrote a story about it, I was immediately flooded by hundreds of emails from readers like you with lots and lots of questions. Some of you read the good news and immediately called Tricare, only to be told that there is no new policy (even though it's on their own website) and that I am liar. Some of you wanted clarification on just how this is all going to work.
You sent me those questions and I went right back to Tricare to get answers. I know you'll have more questions -- leave them in the comments and I'll do my very best to get them answered.
But first, in case you missed it here's the big news: Tricare is now giving every Tricare user free breast pumps, breast pump supplies (as long as you have a prescription) and up to six visits with a Tricare approved lactation consultant after you leave the hospital. The policy officially goes into effect July 1, but it is retroactive to December 19, 2014. That means even if you bought a breast pump out of pocket before July 1 of this year and on December 19 of last year, as long as you have the receipt and prescription, you can submit a claim to Tricare and be reimbursed.
And now for your questions ....
Your Biggest Tricare Free Breast Pump Questions Answered
1. Tricare representatives are denying that there is a new policy at all. Why?
Tricare officials tell me that the representatives aren't informed about the policy because it isn't in effect until July 1. "The anticipated implementation date is July 1, 2015. Thus, beneficiaries should not expect representatives to be educated concerning this change until it is implemented," they said in a statement.
But does that forgive the gross misinformation they are giving callers? For example, one reader told me that they said even if the policy is posted on the Tricare site it doesn't mean it was approved (wrong!). Another said they told him a posted policy still needs to be approved by Congress (wrong again!).
Guys, the only way to say it is this: don't believe everything Tricare representatives tell you about this policy until after July 1. Yes, there is a new policy. Yes, it does cover breast pumps for those who have a prescription. The policy isn't a state secret. You can read it for yourself over here.
2. You said I can get a free breast pump if I have a prescription. How do I get a prescription and what does it need to say?
Easy: just ask your doctor for one. In fact, it doesn't even have to be your doctor. You can get one from literally any provider who can write a prescription, including your baby's doctor. All the prescription must specify is whether they are prescribing a hospital grade, standard electric or manual pump. That's it. Don't know what kind of pump you want or need? Discuss it with your doctor.
3. Where can I buy it?
Literally anywhere. Guys, this policy makes life so incredibly easy it's almost hard to believe. If you know of a Tricare network pharmacy or medical supply store that carries pumps, you can take your prescription there and you won't pay anything out of pocket. If you want to buy it from a retail store or online, do that instead and then submit your receipt and prescription to Tricare as a claim. (Instructions on how to do that are on the Tricare site here).
Don't know how to find a network pharmacy? Go here.
4. What if I'm overseas?
Just like if you were stateside without a network provider handy, you can buy your pump and supplies from literally anywhere including online stores, pay out of pocket and be reimbursed.
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5. Does it have to be a certain brand?
No. Literally any brand is covered, as long as you are buying what your prescription specifics (example: manual vs. standard electric).
6. You keep saying "and supplies." What supplies are covered and do I need a separate prescription for them?
The policy allows you to buy, totally on Tricare's ultimate dime (you'll have to submit a claim, but they will eventually pay), supplies for your breast pump. That includes, per the policy: standard power adapters, tubing and tubing adapters, locking rings, bottles, bottle caps, shield/splash protectors, and storage bags used with the breast pump. It also covers up to two double pumping kits that are specific to your pump.
What's not covered? "Deluxe, luxury or immaterial features that make the pump more expensive than other pumps without those features," according to Tricare officials. Also not covered are "breast pump batteries, battery-powered adapters, and battery packs; regular baby bottles (bottles not specific to pump operation), including associated nipples, caps, and lids; travel bags and other similar carrying accessories; breast pump cleaning supplies; baby weight scales; garments and other products that allow hands-free pump operation; ice packs, labels, labeling lids, and other similar products; nursing bras, bra pads, breast shells, and other similar products; and over-the-counter creams, ointments, and other products that relieve breastfeeding related symptoms or conditions of the breasts or nipples," per the policy.
And no, you don't need a separate prescription for supplies. But when you submit your claim make sure you submit your pump prescription no matter what expenses you are claiming, just to be on the safe side.
7. You said it's retroactive to December 19, 2014 -- what does that mean?
Congress ordered Tricare to start covering breast feeding supplies and support (including breast pumps) starting December 19 of last year. So the new policy is retroactive to that date. That means if you bought a breast pump December 19 or thereafter or any of the supplies we just talked about and you have the receipts and a prescription, you can submit a claim for it.
8. Let's talk about the prescription. What if the date on the prescription is after the date I bought the pump?
No big deal. The pump and supplies do not have to be bought after the date on the prescription, according to Tricare officials.
9. Does my baby have to be born before I can buy the pump or supplies?
Nope. As long as you are pregnant and have a prescription, you can buy it at any time.
10. My baby was born before December 19. Can I get my pump covered?
Yes! They will pay for a pump and supplies up until 36 months after your baby's birth, as long as you bought it after December 19.
11. My baby is almost one. Do I still get a pump? Can I still see a lactation consultant?
Yes again. Supplies, pump and a lactation consultant are covered, according to the policy, until 36 months after you gave birth.
12. I have Tricare _____ [insert type of Tricare coverage here]. Can I get a free pump?
Yes. No matter what kind of Tricare coverage you have or what kind of beneficiary you are (active duty? dependent?) this policy applies to you. Win!
13. When can I start submitting my claim for reimbursement after I buy a pump or supplies out of pocket?
Wait until after July 1. That's when Tricare says the policy is in effect (even though it then covers anything purchased December 19 on). If you submit it before then they'll deny it.
14. I heard about someone who got a free pump already. If they aren't paying for them until July 1, how did she do that?
Two possibilities. She could've been covered under the old policy, which only gives hospital grade pumps to certain premature infants.
The other possibility is that she was able to receive it from a medical supply company that plans to hold off on billing Tricare until after July 1. That's kind of a gutsy move on the part of the supply store, if you ask me, but more power to them.
15. Is this a one pump ever sort of thing, or can I get one each time I have a baby?
According to the policy, pumps are issued "per birth event." That means every time you have a kid, you qualify for a pump. Bonus: if your doctor decides you need a hospital grade pump, you can get a second prescription for a standard electric or manual pump later if she decides the hospital grade one is no longer necessary. Win, again!
Over all, we are very impressed with this policy. Many insurance companies, ordered as part of the Affordable Care Act to cover breast feeding supplies and support, chose to only cover manual pumps -- and that doesn't really help anyone. Tricare has instead found a way to make this fairly painless. And that's a good thing.
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