Why is there an upgrade fee?
According to the Affordable Care Act (ACA) requirements, insurance companies are required to cover a “basic” breast pump. This is mostly classified as “enough to get started”. Items that fall outside of this range would be considered deluxe “upgrade” options. The most common pumps in the upgrade category include an alternate power source - a standard or rechargeable battery option. The basic pumps can all be plugged into the wall, so batteries are not a necessary option. For other deluxe models the differentiator could be extra included accessories pre-packaged with the pump such as a breast pump bag, cooler bag, extra bottles, etc. Again, these items are not “needed” and beyond “enough to get started,” placing them into an upgrade category.
In addition to the above, contracts between the insurance company and the DME providers set an agreed upon rate for claim payment called the “contract rate.” No matter which pump you choose, your insurance plan will only pay the contract rate to us - nothing more, and nothing less. Your free choices will be items that will be fully reimbursed by your plan under their contract rate.