by Patty Hiestand, RN, BSN, IBCLC
Owner, Breasts R Best Lactation Consultants
No such thing as a free lunch? Wanna bet.
Thanks to recent changes to federal healthcare law, babies across America are now ensured help in getting a free lunch (and breakfast, dinner and usually lots of snacks).
As part of women’s preventive services, the Affordable Health Care Act (ACA) requires all new health plans to cover breastfeeding support, supplies, and counseling.
That is, in addition to covering the cost of medical supplies like breasts pumps, the health care law requires all new plans to cover “comprehensive prenatal and postnatal lactation support [and] counseling.”
According to the National Women's Law Center (NWLC), in Washington, DC, this means that "breastfeeding mothers have health insurance coverage for lactation counseling without cost-sharing for as long as they are breastfeeding. Lactation consultants are trained specialists who work with women to help them begin and continue to breastfeed. Health insurers must cover such consultations without cost-sharing, but can require consumers to see only the providers on their list, called 'in-network providers,' or impose other (reasonable) requirements on coverage," such as requiring you to rent a pump instead of purchasing one.
Got it? That means IBCLC-certified lactation consultants can now help you and your baby with all of your breastfeeding issues for as long as you choose to breastfeed. Your insurance company is not allowed to refuse to provide lactation counseling or limit this benefit to those one or two days that you and your newborn are in the hospital. According to the lawyer I spoke with at NWLC, your company also must cover your visit to an out-of-network provider (including home health care providers, whose services are typically less expensive — not to mention more convenient for new families — than clinical visits) if an in-network lactation consultant is not available in your area.
Under the ACA, your insurance company is also prohibited from charging you a deductible, a co-pay or co-insurance for lactation support services.
This is, of course, huge. But I am finding many insurance companies need a push. Whether they are simply ignorant of the law's changes or otherwise motivated, it's time for them to get with the program.
And now there's help. The awesome NWLC legal team recently came out with their Tool Kit: New Benefits for Breastfeeding Moms: Facts and Tools to Understand Your Coverage under the Health Care Law, which you can download free from their Web site. The kit explains the law in easy-to-understand language and includes a list of common questions and answers about the law.
Moreover, the kit includes some great, practical help for dealing with your insurance company should you run into problems, including an actual telephone script that helps ask your provider the right questions and a couple sample letters you can use to kindly — but firmly — set your insurance company straight.
Gone are the days where you or your baby must take "no" for an answer.
The one "glitch" in the law is that health plans that existed before President Obama signed the ACA on March 23, 2010, are considered "grandfathered" and don't have to follow the new rules until the plan makes "significant changes," such as cutting benefits; increasing co-insurance, co-payments, or deductibles or out-of-pocket limits by certain amounts; decreasing employer premium contributions by more than 5 percent; or, adding or lowering annual limits. (NWLC's kit can tell you more.)
Over five years later, however, the reality is that only a small minority — and ever-shrinking — number of health insurance plans still qualify for the grandfather exemption. So odds are that your breastfeeding visit will be covered.
If you have any questions or need further guidance, you can contact the National Women’s Law Center at (866) 745-5487 or email them at: email@example.com.
Finally, I — and I'm sure other parents — would love to hear about your experience with your insurance company. Feel free to email me, or better yet, share that information with others in the comments section, here. I would love to give a public and heartfelt pat on the back to those companies who deserve it — and a motherly kick in the pants to those who need one.
It is a new day for America's mom's and babies!
Have you been denied coverage?
If you are in Washington State and you're having problems convincing your insurance company to get with the program, the Breastfeeding Coalition of Washington is asking for your help. They are working with the Office of the Insurance Commissioner that wants to hear from consumers about problems getting coverage from their insurance providers for services covered by the Affordable Care Act. They specifically want to hear about denials for lactation services, breast pumps and birth control. Please take 5 minutes to file a complaint at http://www.insurance.wa.gov/complaints-and-fraud/file-a-complaint/ or call 1-800-562-6900. These complaints are crucial to ensuring consumers are getting the insurance coverage required under the ACA. It is important to have your insurance card or medical id number available when filing a complaint.
[Thanks to NWLC and my BRB-friendly lawyer-husband for his help figuring all this out.]
What I Do/Do Not Provide (and my Two Cents on Insurance)
To keep my costs low (and to keep things simple), like most home-based lactation consultants I do not direct-bill insurance companies. Instead, I provide you with a detailed "super-bill," which is in the format insurance companies require, with the requisite billing codes, that is ready to be submitted directly to them for reimbursement. My private consultation rates are well below those we used to bill for when I worked at local home health care agencies, so the fee should be covered — but I can't make any promises and if insurance is the determining factor in seeking help, I urge you to call your insurance company first.
That said, I've been doing this work long enough — and have seen the profound difference that it can make in a family's life — that I think it's important to step back from the insurance game (and it is a lousy, unfair and sadly broken game for far too many) for a moment and remember what is at stake. I sincerely believe that breastfeeding is one of the most valuable gifts you will ever give your child. The life-long benefits to both you and your baby in terms of nutrition and physical and emotional well-being have been clearly demonstrated. It matters. But while many parents will drop several hundred dollars (or more) on a new stroller or other baby gizmo, they may forgo working with a lactation consultant (which costs much less) if their insurance company balks.
Please don't give the insurance industry that sort of power over the well-being of you and your baby. Just as you would with any other purchase, I urge you to weigh the costs and benefits — and then make your own decision.
Of course, unlike a new baby stroller, federal law does now require insurance companies to cover lactation consultation services. For many, obtaining reimbursement is as simple as dropping your paid bill in the mail. But if you run into problems, by all means fight like hell with your insurance company. I recommend using the NWCL's helpful telephone script and sample appeal letters to "educate" your company. I also hope you'll "pay it forward" by filing a complaint with your state's Insurance Commissioner.
Insurance Company Responses
The Affordable Health Care Act requires all but a minority and ever-shrinking number of "grandfathered" insurance plans to cover lactation support, supplies and counseling. Please don't take "no" for an answer. To assist others, please send me your provider's determination letter and and I will post the information here. (Click below images to enlarge.)