ConsumerWatch: Federal Breastfeeding Coverage Creating Confusion
SAN FRANCISCO (KPIX 5) - The Affordable Care Act now mandates insurance companies cover the costs associated with breast feeding.
From pumps, to classes, to all of the supplies, breastfeeding can be both complicated and costly. New mom Shermina Takar said so far she's spent, "a little over a thousand on equipment, not including supplies."
Lactation consultant Nancy Held said she hears a lot of confusion about the new mandate. She said each new parent who comes into her center seems to be getting a different answer from their insurer. Some will cover hospital-grade pumps, while others will only over cheap hand pumps.
"We've had instances where someone has a primi in the intensive care nursery and their insurance company gave them a hand pump, and we need to be able to say no you need the hospital grade pump" Held said.
Insurance broker Steven Bauer said the confusion isn't surprising considering the vague language of the law. He said that, because the law doesn't specify breast pump type or brand, some insurers are deciding on their own.
"They all have to agree to cover lactation devices; it's the implementation that's under review," he said.
According to Bauer, often times insurers are requiring less than suitable pumps and even mandating where they must be purchased.
"There's really no one championing the member at this point. The insurance companies default answer many times will be 'no,'" said Bauer.
When asking for help, even the state department of insurance said its hands are often tied. Coverage is dependent on the language of your contract, instead of the intent of the law.
While lactation consultants should be fully covered under preventative care, breast pumps are considered medical equipment. That means coverage varies by policy. Lactation consultants advise new moms to call their insurer before their baby is born in order to find out what's covered and where it needs to be bought.
Takar said her insurer wasn't much help.
"They said they don't cover breast pumps specifically, but they said you can try to submit your receipts for what you do purchase. You can try," Takar said.
If your insurer doesn't give you the answer you're looking for, first ask to speak to a supervisor. If that doesn't work, tell them your going to file a request for assistance with the Department of Insurance. This advice is for PPO policies. HMO patients would report to the Department of Managed Health Care).
The Department of Insurance is asking that consumers call in if they believe their insurers are not in compliance with the Affordable Care Act, which mandates that they cover the rental equipment associated with Breastfeeding as of Jan 1, 2013.
That number is 800-927-4357 (800-927-HELP)
Often, simply telling your insurer that you're going to file a request for assistance with the Department of Insurance is enough to get action.
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