You'll find hundreds of files on cleft lip, cleft palate here on widesmiles.org.

This one is about: Getting Insurance Coverage for Breast Pumps


(c) 1998 Wide Smiles
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A parent writes about her experience getting the insurance to pay for the breast pump and Haberman Feeder:

Hi there!

I'm rather excited because I received a check today which covers my breast pump & Haberman supplies. Both of which I had prescriptions for, but were supposedly not covered items.

When I originally sent the bills in, hoping they might be covered (the pump was over $200), my insurance statement came back saying these were not covered items. I normally would appeal the decision, but didn't because I honestly didn't think they'd be covered. Well, an additional $100 worth of Haberman parts later, I started to wonder if I should give the appeal a try, and called the insurance co. The girl said that those things wouldn't be covered, but if I WANTED, she supposed I could try & appeal the decision (she gave me the impression it would be a waste of
time).

Well, I wrote my letter asking them to please cover at least the Haberman supplies, as they are required to feed my son, and not an option. I mentioned the pump, but assumed they'd skip right past that since breast milk isn't the ONLY food for a baby (I did state that I thought it was something my baby needed). Not long after I sent the letter, the head of the Health & Welfare at the union hall called me asking if I had a prescription for any of this, and I said yes (he later found it), so he said there should be no problem & to go ahead & send in all my other receipts.

So I got 80% coverage, and the check came in very handy this week (short paycheck thanks to New Years). I just wanted to share, hoping to give anyone else the extra push to go ahead & ask that these types of things be covered. I wish I would have done it sooner. Having a CA child sure isn't cheap!

Thanks for listening, I hope someone else can learn from my procrastination.

And here is the letter that was written:

Here's the letter I sent to my insurance. I didn't think the pump would be covered, but I got 80% coverage on both the pump & all my Haberman supplies.
_______________________________________________________________

To: (Your Insurance Company's Name here)
Attn:
Patient: (Child's Name)

To whom it may concern,

My son (name) was born on July 14, 1997, with a unilateral cleft lip and bilateral cleft palate. Due to his inability to form a proper suction, he was unable to nurse successfully. Because I felt he needed the benefits of breastmilk for as long as possible, I bought a breast pump from (name withheld), IBCLC on July 22, 1997. Without this pump, my son was unable to receive the breastmilk I felt was so very important to his health. I have been informed that this is not a covered benefit, but I would like to appeal this decision, because I really had no other way of nursing my son, due to his cleft, and the pump itself cost over $200.

I have also had to purchase special bottles for (name of child), without which he would not be able to eat at all. The Haberman feeders that I have to buy cost $21.60 each, and the teats for them alone cost $9.65. I have had to buy a total of 7 teats so far, in addition to various other parts needed for the Haberman to work properly. I have spent well over $100 already, just to supply the proper feeding device for my son. It is suggested by the manufacturer of the Haberman, that the teat & valve membrane be replaced every five weeks. And since he will need this special bottle, at least until his palate is repaired, I ask that it be covered.

I did not know my son would be born with a birth defect, and had not anticipated so many additional costs. While I have no choice as to whether or not I want to purchase these items, I have to have them in order for my son to receive any nourishment. I had hoped that we could be helped with this additional financial burden, as it is necessary and not optional. Please take this into consideration, regarding the Haberman Feeder parts, and inform me of your decision.

Thank you,
(name withheld)


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