As part of its coverage of preventive health-care services for women, the Affordable Care Act requires many insurance plans to provide equipment and services to promote breast-feeding, like breast pumps and lactation counseling, at no extra cost.
The requirement took effect last summer but kicked in for many plans on Jan. 1, the start of new insurance plan years for many employers.
The coverage could potentially save breast-feeding women hundreds of dollars. But there is considerable variation in what sort of pumps are covered, and how they are covered. The law’s recommendations aren’t specific, so coverage varies from health plan to health plan. Some cover purchase of manual pumps only; others exclude hospital-grade pumps, often used soon after birth to help mothers establish adequate milk flow (although some plans cover such pumps if a doctor deems one medically necessary). Most plans require women to obtain the pumps from designated vendors, which may or may not offer the model a woman prefers; that means women usually can’t buy a pump at retail and submit a receipt for reimbursement.
Further, the health care law exempts plans that meet certain requirements, so not all plans have to provide the coverage, although some may choose to anyway. So even as the law’s requirement fuels demand for breast pumps, some women are uncertain how to go about getting one.
“There is a lot of confusion,” said Judy Waxman, vice president for health and reproductive rights at the National Women’s Law Center, which is urging the federal Department of Health and Human Services to issue more detailed recommendations. “Everybody’s winging it.”
Since coverage varies, the best thing to do is to contact your health plan, using the number on your insurance card. The women’s law center offers a script that can help you determine if your plan is offering the benefits, and how to use them.
A spokesman for H.H.S., Fabien Levy, said in an e-mail that the law allowed for flexibility:
“The law gives health plans the flexibility to decide whether to pay for women to purchase or simply rent a pump, and plans are allowed to use reasonable strategies to manage costs, for example covering only what doctors find to be medically necessary.”
He continued, “The nonpartisan Institute of Medicine recommended this coverage in part because preventive care, like breast-feeding, reduces health care costs by improving health outcomes for the baby and the mother. And, the independent economists at the Congressional Budget Office have reviewed the effects of all of the provisions of the law and found, on the whole, the Affordable Care Act will reduce premiums.”
The provision is one of eight preventive health benefits for women recommended by the Institute, which was asked to develop them by H.H.S. The agency endorsed the recommendations, making them required benefits under the health care law.
A fact sheet on H.H.S.’s healthcare.gov Web site states, “Pregnant and postpartum women will have access to comprehensive lactation support and counseling from trained providers, as well as breast-feeding equipment. Breast-feeding 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 breast-feeding is the cost of purchasing or renting breast pumps and nursing related supplies.”
There are several different types of breast pumps, however, from simple manual models to portable electric consumer models and larger, heavier hospital-grade pumps. Some women prefer initially to use hospital-grade pumps — often available for rent — to help establish their milk supply, then switch to a more portable electric pump when they return to work after giving birth.
As any woman who has pumped breast milk can testify, there is a difference between a manual model and an automatic pump. If you are a working mother who only has short breaks at work during which to pump, it’s unlikely you’ll pump sufficient milk with a manual pump to maintain your milk supply.
An Aetna spokeswoman says its benefit, for plans that cover women’s preventive services with no cost sharing, covers a standard (meaning nonhospital grade) pump within 60 days of birth, every three years, or a manual breast pump within twelve months of birth provided the patient hasn’t already received an electric or a manual pump in the last three years. If you become pregnant before you’re eligible for a new pump, you can still get another set of accessories — typically, tubing and containers — to use with the pump.
Women whose plans don’t cover the pumps without cost can still buy one at a discount through approved Aetna vendors.
A Cigna spokesman said in an e-mail that it developed its coverage based on the federal guidelines. “Cigna covers standard breast pumps as rental up to the purchase price, which is typically reached quickly, therefore the standard breast pump would be purchased for the individual. The breast pumps must be purchased through a national medical equipment company that Cigna contracts with. Hospital-grade pumps are rental only and are subject to precertification.”
Blue Cross Blue Shield of Illinois, according to a summary on its Web site, covers manual pumps only; a footnote explains that “electronic and hospital-grade pumps will not be covered with no cost sharing.”
And United Healthcare says on its Web site that it will cover rental or purchase of electric pumps at no cost to the member who must acquire the pump through an approved hospital or vendor, which will bill United directly for payment.
Have you tried to obtain a breast pump from your health plan under the new law? What was your experience?
Article source: http://bucks.blogs.nytimes.com/2013/01/28/breast-pump-coverage-under-new-law-varies-in-practice/?partner=rss&emc=rss
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