A recent New York Times blog, Breast-Feeding Services Lag the Law, describes the challenges women face trying to obtain this new benefit. The Affordable Care Act, also known as Obamacare, requires “new” health plans to cover certain preventive services without cost-sharing, which means enrollees should not face out-of-pocket costs such as co-payments, deductibles or co-insurance. (If you want more information about which plans are considered “new” see our helpful fact sheet.)
These new plans are required to cover breast-feeding support, supplies and counseling. The counseling component is critical, because some mothers find initiating and maintaining breast-feeding challenging. The law recognizes this difficulty and requires plans to cover “comprehensive prenatal and postnatal lactation support [and] counseling.” This means that breastfeeding mothers now have health insurance coverage for lactation counseling without cost-sharing for as long as they are breastfeeding.
But, as the article describes, some insurance companies may be slow to fully cover this benefit by failing to provide a list of in-network providers, or referring women to other providers like pediatricians who may not be trained in lactation counseling.
While the law requires plans to cover lactation consultations without cost-sharing, they may use “reasonable medical management techniques” to determine the scope of coverage, which can include giving preference to in-network providers. This means that if you go out-of-network you may not be able to get breast feeding help without cost-sharing. But, if your insurance plan does not have accessible in-network providers, your plan must pay for services provided by an out-of network lactation consultant and cover these services without cost-sharing.
In practice, women may encounter problems when trying to find an in-network lactation consultant, or find that their insurance company has not yet implemented the lactation support and counseling benefit. In some instances, the insurance company may not have a list of in-network lactation consultants, leaving women unsure of where to go for services in-network. New mothers may find this insurance maze difficult to manage, and they may—as the article notes—be unable to initiate breast-feeding or continue nursing their infant without this help.
As with any new benefit, insurance companies may experience problems as they begin to provide this coverage. On the other hand, women must be able to receive comprehensive lactation support and counseling, along with breast-feeding supplies as required by the law. So what to do?
We have some resources to help. We have an informative fact sheet and toolkit to help women obtain this important benefit. If you or a woman you know is having trouble obtaining this benefit without cost-sharing, our toolkit includes a sample letter to send to your insurance company. Still have trouble? Call 1.866.PILL4US (this is a hotline for the women’s preventive services, including breast-feeding supplies and support) or email us at email@example.com.