Insurance Coverage for Breastfeeding Services

By Vicki Wolfrum, RN, CNM, IBCLC

The Affordable Health Care Act contains important provisions for breastfeeding mothers.  This act was passed by Congress in March of 2010, signed into law by President Obama and upheld by the Supreme Court during the summer of 2012.  A major feature of the law is that health plans are required to cover recommended preventive services without patient cost sharing.

In August 2012 The Department of Health and Human Services adopted guidelines for women’s preventive services, including well woman visits, support for breastfeeding equipment and lactation services as well as contraception and domestic violence screening.

More information can be found on the website www.healthcare.gov.  This website spells out information about breastfeeding care provisions of the Affordable Care Act:

“Breastfeeding support, supplies, and counseling: Pregnant and postpartum women will have access to comprehensive lactation support and counseling from trained providers, as well as breastfeeding equipment. Breastfeeding is one of the most effective preventive measures mothers can take to protect their health and that of their children. One of the barriers for breastfeeding is the cost of purchasing or renting breast pumps and nursing related supplies.”

The “preventive services” part of the law went into effect in August 2012 and the insurance companies were given 6 months to set up a system to provide lactation services and breast pumps.  Many insurers have made special contracts with Medela, Ameda, Hygeia and other pump companies.   When you call your insurance you may be given the phone number of a medical goods company who will send you a pump and bill your insurance.  Alternatively, your insurance company may ask you to purchase the pump at a qualified hospital or medical goods store and submit your bill for reimbursement.  They may even allow you to purchase the pump directly from your lactation consultant.

Our experience at Best Baby Ever is that most insurers are already providing coverage. Our clients have been submitting superbills for insurance reimbursement for the past 4 years and most have been covered. The provisions of the Affordable Health Care Act makes it likely that nearly all mothers will be covered.

Your insurance type will dictate how you use your benefits under the new law.  Most PPO plans have an out of network option, so that new mothers may visit the lactation consultant of their choice and be reimbursed by their insurance.  HMO plans will require that parents stay “in network” for services to be covered.  Contact your insurance company to find out what your own benefits are.

Vicki.photoVicki Wolfrum has practiced as a nurse-midwife, a woman’s health care practicioner, a menopause specialist, and a lactation consultant. She is a mother of five, a grandmother of nine and brings to her passion for families in a “wholistic” manner to Whole Life Home Health Care as its founder and president. Vicki is also on the board of directors for the San Diego Breastfeeding Coalition.  Please email Vicki at vicki@wholelifehomecare.com if you have experience with your insurance and coverage for breast pumps and lactation consultations.  Vicki will work to ensure that all new mothers eventually receive all the benefits to which they are entitled under the law.  Vicki and her colleagues are available to provide lactation support services to Coast Pediatrics Del Mar families who need them!

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