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.

 

 

 

Breastfeeding Help from your Physician? Maybe Not.

photoBreastfeeding is something that every mother and every baby has a right to do. More importantly, it is widely accepted as the preferred way to feed a baby. We can all rattle off numerous health risks to mom and baby that can result from artificial feeding. It follows, then, that our health care providers—especially those who are charged with the task (and privilege!) of supporting new mothers and vulnerable infants—would be well versed in how to support the breastfeeding dyad. Tragically, this is sometimes not the case. Continue reading

Low Milk Supply: Tricky to Treat!

Supplementing at breast

Supplementing at the breast.

When a mom is experiencing difficulty making enough milk for her baby, the usual suggestion from well meaning professionals is often, “Nurse your baby more —your body will rally and you will make more milk in just a few days.” This suggestion is based on the law of supply and demand. When more milk is removed from the breast, the breast will respond by making more milk. While this advice can be legitimate in some situations, many times it can result in an exhausted baby who, despite mom’s best efforts, can’t get enough milk to gain well. Continue reading

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