Working With Your Insurance Company to Cover Lactation Support

And my two cents on the insurance game

by Patty Hiestand, RN, BSN, IBCLC

No such thing as a free lunch? Wanna bet.

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Thanks to 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).

The Law

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 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 clinic 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.

The Reality

This is all, of course, wonderful news for you and your baby. 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.

  The National Women's Law Center's free "Tool Kit: New Benefits for Breastfeeding Moms: Facts and Tools to Understand Your Coverage under the Health Care Law," explains the law in easy-to-understand language.

The National Women's Law Center's free "Tool Kit: New Benefits for Breastfeeding Moms: Facts and Tools to Understand Your Coverage under the Health Care Law," explains the law in easy-to-understand language.

Fortunately, there's help. The awesome NWLC legal team has published 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 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.

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: prevention@nwlc.org

Have You Been Denied Coverage in Washington State?

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.

Finally, I — and I'm sure other parents — would be grateful to hear about your experience with your insurance company. If you’re willing to share your benefits letter, I will post a redacted version here.

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.  (Click below images to enlarge.)

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