It’s been a year since the Affordable Care Act (also known as Obamacare) began requiring insurers to cover “breastfeeding support, supplies, and counseling” with no co-pays.
This was a very welcome development. But in the absence of specific guidance on what should be covered, insurers’ response to these requirements has been uneven and often difficult for women to decipher.
It’s been, in the words of the U.S. Breastfeeding Committee, “chaos,” with “families across the nation reporting extreme inconsistencies in coverage and disrupted continuity of care,” and some “caught in a maze of paperwork that takes weeks to resolve, or are told (erroneously) that breastfeeding support and equipment is simply not covered at all.” To “calm the chaos” surrounding these inconsistencies, the U.S. Breastfeeding Committee released a model insurer policy last month to try to give guidance to insurance companies by identifying best practices.
Further evidence of these problems arrived earlier this month when the National Breastfeeding Center issued a scorecard grading 100 insurance companies on their compliance with the law. They scoured the published policies of these companies to determine if and how they were meeting the new requirements. What they found was some wide variation:
“We were encouraged to find that some insurers really recognize the importance of improving breastfeeding and support the intent of the mandate by covering fully qualified lactation care providers and effective breastfeeding equipment. But many more provide only the bare minimum required by law, such as a manual hand-operated breastpump and advice given during a well care exam by providers that may have little lactation care experience.”
At the top of the rankings were Aetna, Anthem Blue Cross Blue Shield, and Blue Cross Blue Shield of Montana and Nebraska, which earned grades of A or A-.
At the bottom, earning a grade of F, were Capital Health Plan, HealthNow New York, Humana, MedMutual of Ohio, Mercy Health Plans, Paramount Care, Preferred One, Sanford Health Plan, Total Health Care USA, and Blue Cross Blue Shield of Louisiana, Tennessee, Kansas City, and Florida.
The National Breastfeeding Center gave highest scores to companies which covered breastfeeding support through coverage of classes and visits in the hospital, home, and office by qualified lactation counselors either in-network or out-of-network, and those that covered the rental of hospital-grade pumps required when medically necessary, and the purchase of electric pumps through multiple sources.
Companies ranked the lowest were those which covered only manual pumps and provided breastfeeding support only as part of routine care (such as during a well child visit) from in-network providers of unknown training and qualifications.
Until all insurance companies provide adequate support and make it easy for you to figure out how to access it, here’s a resource to help you figure out what’s covered under your plan.
Have you tried to figure out what breastfeeding support your insurance company covers? What has your experience been like with your insurer?