Ten Facts You Must Know about Insurance and Breastfeeding Support

My dear colleague and friend, Joy Funston, recently attended a webinar to understand the rights of the breastfeeding mother under the Affordable Care Act. (In the US) She graciously shared what she learned with her colleagues. We collaborated to write this post and bring this important information to as many mothers and mothers-to-be as possible.Thank you Joy!!

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If you are in the U.S, you have probably heard that the Affordable Care Act (ACA) mandates insurance coverage for lactation support. You are correct! Unfortunately, the details of the law are vague,and that has created loopholes for insurance companies to jump through.

For example,  the law requires that insurance companies develop a network of breastfeeding professionals. The may “say” they have a network of lactation consultants, but on closer inspection, it is found that lactation services will only be a covered expense if they are provided by a licensed medical professional such as an M.D.  As we know, the vast majority of M.D.’s do not provide lactation services.

Another important aspect of the ACA is mandated coverage for breast pumps & supplies. Unfortunately, no details are included. What type of pump?  Who decides?

The National Women’s Law Center in Washington, DC has attempted to be a resource for moms trying to access coverage and to IBCLC’s offering assistance. The following information is from a webinar that they provided. 

Know your rights! If your insurance company has denied lactation services by an IBCLC, here are the points that you can argue with your insurer:

1.The lactation portion of the ACA states that specific benefit are covered “for the duration of breastfeeding.” Insurance companies are not in compliance with the law if they have arbitrary rules for a set number of consultations or certain age of the baby. There are a couple of exceptions: “Grandfathered plans” and some private “self-insured” plans do not always have to follow the ACA.

2- IBCLC’s are ready and available as trained experts in lactation. No other credential comes close. And no other credential is needed. 

3. While not the intent, ineffective breast pumps satisfy the law. The ACA does not specify the quality of a pump.  Note from Renee: Given the law as it is now, I recommend purchasing your own pump if your insurance company will not provide the type that you need. .

4. The ACA does NOT include a requirement of return to work or school for breast pump coverage.

5. Tricare, insurance for military personal, is NOT covered by the ACA. But things are changing. Recently there was a mandate for covered benefits by the armed forces appropriation’s bill.

7. New marketplace plans ARE, in fact, covered by the ACA.

8. The law mandates “no cost sharing” for lactation support services. This means no co-pay, no deductible and no co-insurance cost. Period.

9. Each insurance company is supposed to provide in-network professional lactation support options. If there is no in-network option provided which is geographically accessible, you may go out of network for support. Keep in mind that the vast majority of insurance companies do not allow IBCLC’s to become in-network providers. The insurance company can use this to deny benefits. This is a “Catch 22” situation and needs to be reported.

10. Any complaints about insurance noncompliance should go directly to your state’s insurance commissioner.  Every time. Every mom. Every problem. Note from Renee: Washington state’s insurance commissioner is very responsive! Documentation of insurance noncompliance can also be reported to www.coverher.org.  They hope to continue to compile data & to be a resource.

And finally, part of the ambiguity in the implementation of the ACA is that the insurance companies are not acknowledging who actually is the expert breastfeeding professional. IBCLC is an international recognition– the only professional qualified to step into the role the law envisioned. But IBCLC does not come with a “license” and in the USA, Insurance companies traditionally reimburse the services of licensed professionals only. Please support state licensure of IBCLC’s when you can.

Sadly the law was not precise… But the intent was very clear. Mothers are absolutely entitled to healthcare benefits for lactation support. Consumers need to demand the coverage their premiums are mandated to provide.

Joy Funston, RN, IBCLC. RNC is in private practice in Charlottesville, VA.  She can be reached at www.joyfulstartlc.com.

 

 

 

I’ve Lost my Milk! Is it Possible to Relactate?

From first-time mom, Shelly:

In honor of World Breastfeeding Week, I’m making a toast: Here is to trying again. Here is to providing the best for my baby. Here is to hard times. Here is to when you thought it was all over and starting anew.

Shelly's baby--latching again!

Shelly’s baby–latching again!

The back-story from Shelly:

I am in the process of getting some health issues under control which I know has contributed to declining milk production since about 5 months. So now, at 7 months, my daughter shows little interest in the breast. If I completely stop providing milk for her now, would it be possible to re-establish in a couple months once I can get my own body under control? I have PCOS and thyroid issues and it has taken a while to get into a doctor to re-test hormone levels and get it treated. I would love to keep giving her breast milk once I can produce again, but I really need to focus on me right now.  I am exhausted every day to the point where I can barely take care of my daughter. Adding in pumping would be too much!

Renee’s response: I think what you’re saying is that pumping would be too difficult for you with your health issues? Yes it’s possible to re-lactate. but not easy.

It’s nice to know it is possible. I just didn’t want to get my hopes up if there was little to no chance at all.

Here’s an update from Shelley.. a month later:

After my milk supply decreased, I started my baby on solids and tried formula, but wasn’t happy with it. I switched to a EU (European) brand that I still use now. Over the past 2 1/2 months, not surprisingly, my supply dwindled to just about nothing.  I had realized that getting to 6 months with breastfeeding was a huge thing to be proud of; something most women in my family never got to experience.  After learning that it was possible to get my milk back,  I decided to try last week. It was time to get back into it, no matter how hard it was. So I started pumping again. She needs my milk. If I never can 100% breastfeed again, that is fine. But I want her to want me when she is hungry, not the bottle. This morning I tried to breastfeed for the first time in many weeks. She latched on!! It only lasted a minute or two, but it was something. It was a start. There is now hope that I am not insane and this could actually work.Thank you for your support and encouragement!

 

Thank YOU, Shelly for sharing your story with us!

Note: If you are interested in resuming breastfeeding after cessation, please contact an IBCLC experienced in helping with relactation and inducing lactation. She can help you develop a plan that is right for you.

Take off and Let Downs–Pumping and Air Travel

Breastfeeding: Sweet. Intimate. Close connection between mother and baby. It’s a lovely soft-focused kind of image, right?

DSCN1910Unless you have to be separated from your baby for work or school. Then it’s all business. Maintaining milk production. Tallying the ounces in the freezer. Strategizing about how to get one more pumping session in every day. Stressing if you have low output at lunch or if someone schedules a meeting during the time you’re supposed to be pumping.

And what if you need to be away from your baby for more than one day? What if you need to travel for your job sans baby? What if you need to be on an airplane for more than a few hours? Is it possible to pump on a plane, maintain your milk production, save your milk AND bring it home for your baby? Continue reading

Breastfeeding SOS: A Glimpse into a Monday Morning

Breastfeeding SOS

Breastfeeding SOS

I used to facilitate a breastfeeding drop in group.  I never knew what to expect or who would show up. Sometimes clients pop in for a quick follow up, but often I’ve never met the moms before. They are referred to the group by their Drs, their doulas, the acupuncturist or their friends. This is a glimpse into a recent drop in.

After moms straggle in with their babies somewhere between 10:20 and 10:45. They get settled in the comfy chairs and I ask them to introduce themselves and their babies.  They admire each other’s babies. A mother with a 3- month- old marvels at the smallness of another mom’s 8-day-old baby. She congratulates her for making it out of the house to get support with such a tiny baby.. I ask the mothers to talk about why they are here. Here is what I heard last week.

“I just want to make sure I’m doing it right.”

“I want to make sure my baby is gaining weight.”

“My nipples are really sore.”

“My baby has a hard time latching and he’s really fussy at the breast.”

“I’m using nipples shields and I want to breastfeed without them.”

Babies begin to get restless and fussy.  I assure them it’s totally fine to breastfeed in this setting!  A question is asked about latching. All eyes are on me as I  bring out my knitted breast and demonstrate for all to see. I can see mothers trying to replicate the technique I demonstrated.

There is concern expressed about using some formula. Everyone is quick to assure the mom that any amount of breast milk is great and the important thing is to feed the baby.

There is a discussion about milk supply and how to know baby is getting enough.

More questions.. I give general answers. If a mother is having a complex breastfeeding problem, I recommend a consultation with an IBCLC. She can make an appointment with me if desired.

A mom shares that she isn’t getting enough sleep and she doesn’t know what to do. Three other moms nod their heads with empathy and give her suggestions. I merely listen, because it seems the mom is getting exactly what she needs.

A conversation about pumping ensues. One mom says.. “I have a love/hate relationship with my pump!”  There is laughter and more pumping discussion.

A baby poops loudly which results in more laughter.

A mother asks me to help with latching her baby so that it’s not painful. I help her make a few adjustments and she looks up at me and says, “That feels better! Thank you!”

A mother confesses she doesn’t know how to determine if her baby is swallowing. So I sit with her and interpret what’s happening as her baby nurses. Another mom listens in, then asks me to watch her with her baby as well.

Every few minutes a baby is weighed. When it’s good news all of the mothers rejoice.One mom cries after learning her baby didn’t gain enough weight—other moms cry with her or grow silent.  One reaches out and gently pats her back. They always seem to know the right thing to do.

A mom asks me to check if her baby has thrush. I don’t do oral exams in drop in groups, but this baby took one look at me and stuck out her tongue and showed me the thick white patch!

When one baby cries loudly, the other babies look worried and begin to whimper. I hear things like, “Yes, that baby is sad, but his mother is helping him.” and “That is a loud sound and it’s scaring you.” and “I’m right here, you are ok.” I marvel at the intuition and skill of these first-time moms.

Babies fuss and cry with diaper changes. A mom goes to use the restroom and hands me her baby to tend. He smiles and coos at me.

It’s 11:30… time to end the meeting. But the moms linger… asking one more question, enjoying the company of other moms and babies. There are hugs and word of encouragement.

When they leave they look a little happier, a little lighter and more confident. They have a plan. They know who to call if they need more help. They entered the space as strangers and as they leave, I hear 2 of the moms exchange phone numbers.

I hope they are all doing well. I hope I see them next week.

Thankful for Breastfeeding

Thankful for baby bliss.

Thankful for baby bliss.

Recently a client sent me a nice note with a generous check. She had been feeling gratitude for the help she received to breastfeed her son. There were multiple lactation consultations in her home, a frenotomy (the procedure to release a tongue tie) and body work for baby. There were many up-front costs–some of which were not covered by insurance. Here’s what she wrote: Continue reading