Lactation coverage falls short of ACA requirements

Although the healthcare reform law requires insurers beef up coverage of lactation consultants, breast pumps and other breastfeeding-related services, many companies still aren't paying for the care--or even including lactation consultants in their networks, reported the New York Times.

As a result, many new mothers in search of needed help for breastfeeding problems have nowhere to turn for quick action or a timely response.

"It's abysmal, the state of lactation services being provided by insurance companies currently," said Susanne Madden, a founder of the National Breastfeeding Center. Her organization published a review of insurers' breastfeeding policies, with 28 of 79 insurers receiving Ds or Fs.

Instead of paying for lactation consultants, some insurers refer new mothers to in-network ob-gyns or pediatricians for breastfeeding help. "It's the lactation visits that many insurers are not covering, the face-to-face clinical evaluation by somebody who can provide a higher level of care," Marsha Walker of the U.S. Lactation Consultant Association, told the Times. "A physician doesn't have the time and, a lot of times, does not have the training to do this."

Insurers also have refused to pay for lactation consultations unless performed by in-network consultants with state-recognized certifications. But if insurers don't have certified lactation consultants in their networks, then they must cover one out of network. However, the reform law doesn't clarify what constitutes as a "trained provider" of lactation counseling.

The one noted exception thus far has been Aetna, which already has begun including lactation consultants to its provider network, FierceHealthPayer previously reported.

The U.S. Department of Health & Human Services said it will help insurers comply with the law so that new mothers can obtain coverage for lactation consultants and breast pumps, for example.

To learn more:
- read the New York Times article