Booby Traps Series: Anthem gets an A, Humana gets an F. What grade did your insurer get in support for breastfeeding?

Written by Tanya Lieberman, IBCLC

Bottle_of_Pumped_Breast_MilkIt’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?

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10 Comments | Last revised on 09/20/2013

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10 Responses to Booby Traps Series: Anthem gets an A, Humana gets an F. What grade did your insurer get in support for breastfeeding?

  1. Liz Brooks JD IBCLC FILCA says:

    Thank you for sharing news of this Scorecard! It may help mothers convince the lagging insurance companies to “step up.” Breastfeeding is a public health imperative; women, and their children have decades of improved health when there is breastfeeding in the picture early on. It’s not just about having “healthy babies.” It is about babies who grow up to be healthy adults! By covering without co-pays (and without hassle) the skilled breastfeeding care or equipment a mother needs *now,* families are supported, families have improved health, and insurance companies pay less for decades to come to cover sickness care!

  2. Nicole says:

    My insurance company, BCBS-SC earned a B-, but because I was “grandfathered-in”, could not get a breast pump.

  3. Tabatha says:

    I have Geisinger Health Plan family in Pennsylvania and it covers only a few breastpumps and all of them are electric and lactation consultants are covered with a referral from your doctor. At least that’s what I was told by their reps I didn’t really get too far with them they didn’t seem to know much only that I need a referral for everything and there was only a minimum amount of coverage.

  4. Kelli says:

    Mine got a B… I called before my baby was born to find out what my benefit was for a pump. I was told I could only get a hospital grade rental pump. Great for those who need that, but it was more pump than I anticipated needing (for returning to work). As it turned out my baby was premature and I did us a hospital grade pump, but only for a couple days until she was breastfeeding fully and I used the one provided by the hospital. I had to buy a pump out of pocket for going back to work. I wish there were more options for pumps for a wider variety of needs. But I am grateful that the option was there if I had needed a hospital grade one for longer.

  5. Meg M says:

    Thanks for this post! I posted the score card publicly on my insurer’s facebook page and asked them how they planned to fix their grade of “F”. We’ll see if they respond…

  6. AM Gruber says:

    My employer is self-insured. They only cover manual pumps. Might as well cover nothing. Not sure what action steps to take. First working on getting a lactation room, then a written policy, then will work on the insurance part.

  7. Emily H says:

    Sadly, I have to give Aetna a much lower grade. Sure, they paid for a new breast pump, but that was the extent of their help. My daughter needed a procedure to correct a tongue and lip tie that would enable her to breastfeed successfully and avoid expensive formula (which Aetna paid for with my first child). I spent almost $600 out of pocket, and Aetna still refuses to compensate me in any way. Had I not paid for the procedure myself, Aetna would be spending thousands on special formula for my daughter. Which seems more pro-breastfeeding?

  8. Windi says:

    Any idea when/if grandfathered plans will have to start complying?

  9. Tanya Lieberman, IBCLC says:

    Hi Windi,

    I haven’t heard of any movement to change this. But the National Women’s Law center notes that “if you have employer-sponsored insurance, at the next open enrollment you can look at the materials to see if the plan becomes ungrandfathered or if there is another plan option.” (This page addresses coverage for other preventative women’s health services, but the same requirements apply)

  10. Michelle Jones says:

    I had issues finding out which pump was covered. Eventually I stumbled on – I entered my info and they emailed me which pumps were covered and a link to get the pump. I just filled out my info and they shipped it to me – I didn’t pay a penny. They handled billing insurance and everything.

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