The Reality of Insurance Coverage for Breastfeeding Moms
Why the Affordable Care Act doesn't necessarily guarantee coverage for breastfeeding.
When the Affordable Care Act was written to include support of breastfeeding—including supplies and counseling—as preventative care coverage, there were lots of shouts of glee from not only nursing and expecting mothers, but also from advocates of breastfeeding. This regulation was to become effective August 2012. So when I became pregnant with baby #2 early in 2013, I was elated, especially as a working mom who had issues with breast feeding supplies with a past child.
What I’ve come to discover, though, is that not all insurance companies are made equal. And because of the vagueness of the Affordable Care Act, it’s become apparent that some insurers are not providing as much support and ease for women as originally thought. This summer, when I called my insurance company to find out their specific regulations, I was sent on a wild goose chase, and eventually gave up on the endeavor—for the time being.
I was told that I could get 100% coverage of a breast pump if I purchased one through a Durable Medical Equipment (DME) company that my insurance provider considered preferable. The first company they sent me to couldn’t help.
When I called back, I voiced my frustration and was finally given a local contact for another DME company. I went online to research what my breast pump options were before calling, and they only had a “Medela Pump in Style”, as well as another breast pump I wasn’t familiar with. I had a Pump in Style from my first daughter and had little success with it. I called again to see if there was anything else available. However, I eventually found out that breast pumps were back-ordered and it would take 30 days to receive one. Sigh.
Moreover, the problem was that I wasn’t close to my due date and wouldn’t be able to order one until after birth, and waiting 30 days or more to receive a breast pump seemed out of the question. I began to hear other stories from moms and breastfeeding advocates mentioning this problem. The support written in the Affordable Care Act was there, but DME providers were lacking in their match of this support.
I did have other options. I could ask my doctor write a prescription for a breast pump. Or I could purchase one on my own, submit my receipt with the prescription to my insurance company and hopefully get most of it covered. Here’s the kicker, though. My insurance informed me that technically the breast pump would be covered under baby #2′s insurance. So once again, I’d have to wait (the first three weeks of her life she was under my insurance). As well, when I asked how much would be covered, I couldn’t get a straight answer. It all depended on the code the doctor writes down on the prescription, and of course I couldn’t be privy to that information
As you can see, not all insurance companies and DME’s are fully up to speed to help moms. There is so much bureaucratic red tape involved that prevents it from being easy to attain the help you need.
I haven’t had a chance to look into the other aspects of support provided (like lactation consultants), but I have heard that those services are equally as problematic when it comes to insurance companies and approved consultants. Many companies are still referring parents to in-network pediatricians and OB’s who aren’t experts.
The National Breastfeeding Center decided to do its own research and give insurance companies a grade on how they are upholding the promises of the Affordable Care Act. They published a Breastfeeding Policy Scorecard last month. They looked at types of services covered, types of providers covered, and types of pumps covered. Criteria or restrictions on the coverage, for example only offering support for premature and/or sick babies or moms who can’t breastfeed, were also evaluated. Out of the 79 companies looked at, only 25 received grades of A or B. And as a teacher, if I saw that only 31% of my students were meeting standard, I would know that a huge overhaul was needed to get the rest on board. Hopefully this will be a wake-up call to the many insurance companies receiving poor grades.
In my continued research of the laws surrounding insurance, I found that the National Breastfeeding Center published a Model Policy to help inform insurance companies and individuals about proper breastfeeding coverage. The most helpful part about this document, besides clearly defining how insurers can support families, is the fact that they provide all the prescription insurance codes, from lactation consultants to breastfeeding supplies. Now I feel like now the ball is in my court, as I’m armed with knowledge.
I have not given up on getting a new breast pump or supplies covered by my insurance company. I plan to call again in the next few weeks, demand to speak to a supervisor who knows what’s going on with this portion of my policy, and get a plan in place for ease of support once baby arrives. As any new parent knows, dealing with all this legalese and red tape is the last thing you want added to your plate as you care for a newborn. And I hope as the years go on, more insurance companies will get up to speed with how they can support moms. The laws were written, after all, to help encourage more attempts at breastfeeding as well as boost longevity. However, as many companies stand now, they are just making it more difficult to access support for the average mom and average newborn.
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