Nursing moms are struggling to obtain the payments that are promised to them through the Affordable Care Act.
A group of women in Illinois are currently battling with their insurers over the issue of insurance coverage for breast feeding and related health services, as is required by the health care reform of 2010.
The moms are saying that their insurers are denying claims that request full payment for lactation consultants.
Many women find that certified lactation consultants provide invaluable advice and relief when they are first learning how to breast-feed their babies or when they face struggles in being able to do so. Nursing can quickly become difficult or even painful in the days that follow giving birth and women often turn to these experts for the assistance that they need. The Affordable Care Act has labeled breast-feeding benefits as a form of preventive service like screening for certain cancers, and like contraception. The law requires insurance coverage at no cost to the health plan owner.
However, some moms in Illinois are saying that when they submit their claims to their insurers, they are denied.
This recently led a nonprofit advocating breast feeding to new mothers, Breastfeed Chicago, to issue a letter to the Illinois Department of Insurance that requested that the insurance companies in the state be required to pay for certified lactation consultant services. The organization’s board chairperson, Katrina Pavlik explained that “Moms are not getting what they’re supposed to be getting under the ACA.”
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That said, from the side of the insurance companies, they state that they are in full compliance with the federal health care reform law, which says that they must cover “comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum period.”
Two among the largest health insurance companies in the state – UnitedHealthcare and Blue Cross Blue Shield of Illinois – have explained that when doctors, nurses, and breast-feeding specialists within the provider networks of the policyholders are consulted, they provide full coverage for the service.
Unfortunately, when many of the women asked their insurers about certified consultants, they were told that there weren’t any on their networks, said Breastfeed Chicago. When those women hired an expert out-of-network (because their own didn’t have one), they were refused reimbursement.