Under the Affordable Care Act, women have free access to many preventive health services, but they've especially latched on to breast-feeding benefits that provide new moms a free breast pump.
However, women trying to receive their breast pump are discovering the benefits vary and, in some cases, demand has exceeded supply.
As part of the expanded access to preventive services for women, new health plans must cover and eliminate cost sharing, such as co-pays, on certain health screenings and doctor visits, as well as lactation support and counseling and costs for renting breast-feeding equipment. The law kicked in Aug. 1 but doesn't affect insurance plans until they renew, which for many was Jan. 1.
Breast pumps, which can cost as much as $300, are especially important for mothers returning to work who wish to continue breast-feeding their babies, experts say. Hospital-grade rentals typically run $50-$60 a month but most insurers are choosing to provide the mother with her own pump rather than pay for a rental.
“As moms are finding out about it (the provision), they are thrilled,” said Becky Mannel, lactation manager for The University of Oklahoma Health Sciences Center. “There is a huge need.”
The law doesn't specify whether health insurers must cover certain types or brands of breast pumps. Blue Cross Blue Shield of Oklahoma, for example, provides a manual pump, which costs about $30 and isn't sufficient for most working mothers. The company has 700,000 members in Oklahoma.
Other providers, like Aetna and UnitedHealthcare, which cover 190,000 and 350,000 Oklahomans respectively, allow for a pricier double-electric model under most plans.
Some women are being denied altogether; the changes apply to non-grandfathered plans and new plans as of Aug. 1, 2012. Those insured under a grandfathered plan or a plan that hasn't yet renewed wouldn't qualify.
Keri Kelley, who gave birth in July and works for Chesapeake Energy Corp., called her insurance carrier, Blue Cross Blue Shield, last week and asked about the breast pump benefit. She was told her plan wasn't covered yet and she would only qualify for a manual pump anyway.
“The electric is best for me so that I can work while I pump three times a day,” she said.
Even more frustrating, some moms who are approved are encountering a breast pump shortage at medical equipment suppliers, where their health insurers require the pumps be purchased.
One supplier, Edgepark Medical Supplies, has this message on its website: “We are experiencing a shortage of breast pumps nationwide and are unable to take breast pump orders at this time. We are sorry for the inconvenience.” Phone calls resulted in the same message with no opportunity to talk to someone or leave a message.
On the website of another supplier, Genadyne, there's no mention of a shortage but calls to the company's toll-free number this week were consistently met with a recorded message saying there were no representatives available due to the volume of calls.
Leah Lloyd, whose son is 8 months old, was able to receive a free breast pump through UnitedHealthcare with little hassle. She said she hit a few roadblocks with two medical suppliers but found one — Apria Healthcare — that accepted her insurance with a prescription from her doctor. She was able to pick up her new double-electric breast pump in Oklahoma City the next day.
“It was a lot easier than I thought it was going to be,” Lloyd said.
Breast pump maker Hygeia is offering mothers who were denied coverage of a breast pump or unable to obtain one through a medical supplier a coupon for $150 off one of its breast pumps, said Sheri Wallace, marketing director. She said the Fullerton, Calif., company's staff felt bad for all the mothers struggling to get a pump.
“I think moms have to be proactive and persistent and they have to keep going,” Wallace said. “For the most part, nobody wants to see them stop breast-feeding or lose (milk) supply because they don't have a pump.”
Hygeia posted information on its website to help mothers navigate the insurance system and locate a pump. Hygeia's products are sold through medical suppliers and available to UnitedHealthcare customers.
In addition to providing breast-feeding equipment, the Affordable Care Act requires insurers to provide “comprehensive lactation support and counseling by a trained provider during pregnancy and/or postpartum period.”
Blue Cross Blue Shield of Oklahoma said lactation consultants are available through in-network hospital facilities; breast-feeding support also can be provided through a registered nurse, said Hilarie Houghton, senior supervisor of public relations. The insurer will cover lactation counseling when billed by inpatient facilities or by licensed nurse practitioners.
However, when contacted by a customer, a Blue Cross Blue Shield representative said there weren't any in-network lactation consultants listed in its directory.
Aetna, on the other hand, sent letters to all board-certified lactation consultants in the country and asked them to become providers.
Mannel, lactation manager, said because insurance companies are new to covering lactation benefits, there are still wrinkles to be ironed out.
Historically, mothers have either had to pay out of pocket for these benefits or acquire them through Medicaid In Oklahoma, Medicaid doesn't provide a breast pump but WIC, the federal Women, Infants and Children nutrition program, often does.
That left middle-income mothers out of luck, Mannel said, and the benefits included in the Affordable Health Care Act help close the gap.
As moms are finding out about it (the provision), they are thrilled.”
Lactation manager for The University of Oklahoma Health Sciences Center