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 your 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.
And your cost: Nothing. Nada. Zero. Under the ACA, your insurance company is 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 (as yet another insurance company representative told my lactation claims specialist just yesterday) 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 (although a few already covered some lactation support services and must continue to do so) until the plan makes "significant changes," such as cutting benefits significantly; 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.)
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: firstname.lastname@example.org.
Finally, I — and I'm sure others 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, below. 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. (Can we hear the choir sing Amen?)
[Thanks to NWLC and my BRB-friendly lawyer-husband, Mike, for his help figuring all this out.]