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.

 

 

 

Tongue Tie and Social Media: Concerning and Confusing!

This post was co-written by Renee Beebe and sister IBCLC Jessica Altemara. Thank you Jessica for your inspiration and professionalism! 

20140828_095301Some lactation professionals have been trying to address a lack of understanding regarding tongue ties and lip ties for many years. They wanted it better known that tethered oral tissue (term used to refer to all types of “ties”) can negatively impact breastfeeding. But now, with the advent of instant-access social media, we are seeing a trend that is a bit disturbing to these same advocates. We see mothers diagnosing their babies’ tongue ties based on images they see on a Facebook group. We see professionals saying to mothers: “That baby needs a frenotomy,” based on a picture posted to Facebook.  Continue reading

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

Nursing Your Older Baby or Toddler

 

DSCN2783The word breastfeeding typically conjures up soft-focus images of mom/baby blissful, peaceful togetherness. The baby is still, looking up into mothers eyes, or perhaps drinking with eyes closed. Mother has a dreamy look on her face as she enjoys the warmth and glow of oxytocin. It is a beautiful, serene picture.

As you baby grows, things may change. You will still get those sweet, sleepy nursing times. But when awake, your older baby will want to move. She may even want to move while she is attached to the breast. She may put her foot in the air. Or on your shoulder!  She may want to nurse standing up or upside down. She will want to see the source of the noise across the room. She wants to interact with big sister without letting go of your precious breast. And often, she doesn’t seem to realize that the breast is attached to YOU! We often call this “acrobatic nursing.”

DSC_0779Some older nurslings will find it absolutely necessary to keep at least one hand busy throughout the nursing time. Your baby may want to play with your hair, your necklace or a toy. He may even want to hold the other breast. Even though all of these behaviors are perfectly normal and developmentally appropriate, I’m the first to admit they can be annoying.

Breastfeeding is a relationship between 2 people. If there is something going on during breastfeeding that is painful or you simply don’t like it, it’s perfectly ok to say so! When your newborn baby didn’t latch correctly and it hurt, you broke the latch and tried again. If your toddler is amused by pinching your belly fat while she’s nursing and you don’t like it, you can let her know it’s not ok. It’s completely appropriate for you to set limits. It’s your body! If, on the other hand, you find your nurslings acrobatics amusing and cute, by all means, enjoy!

64256_10153268688688448_8493501332460479548_nOne of the truly wonderful and often overlooked benefits of nursing toddlers is the immediate pain relief it provides. Toddlers fall—a lot. They bang into things. They get frustrated by what they can’t do yet. A quick dose of your milk will often cure whatever has made your toddler dissolve into tears. Whether it’s rage or pain, nursing is nothing short of miraculous.

Enjoy your nursling. This time is short. Soon he’ll be running around having fun with his friends and will simply be too busy to cuddle with mommy. Oh, ok.. maybe just a little!

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See also, “Breastfeeding and Biting: Tips to Avoid Those Teeth!” And “Weaning: What’s Normal?”

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