Transcript: Breastfeeding Support: The Affordable Care Act

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The Boob Group
Reimbursement Breastfeeding Affordable Care Act
Episode 54

[00:00:00]
Please be advised, this transcription was performed from a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription.
[Theme Music]
Robin Kaplan: In August 2012, the United States Government passed the Affordable Care Act which stated that American Insurance companies needed to provide without cost to pregnant and postpartum women access to comprehensive lactation support and counseling from trained providers as well as breastfeeding equipment. Since then, American insurance companies have all interpreted this mandate differently from one another which has made this process very confusing for new parents and lactation consultants alike. Today I’m excited to introduce Suzanne Madden, the COO of the National Breastfeeding Center and this is the Boob Group Episode 54.
[Theme Music/Intro]
Robin Kaplan: Welcome to The Boob Group, Broadcasting from the Birth Education Centre of San Diego. The Boob Group is your weekly online on-the-go support group for all things related to breastfeeding. I am your host Robin Kaplan. I am also an International Board Certified Lactation Consultant and owner of the San Diego Breastfeeding Center.
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So, today I am joined in our studio today by three lovely panelists. Ladies, will you please introduce yourselves?
Cherri Christiansen: Hi! I am Cherri Christiansen, I’m 32 and I work in consumer research, although I’m actually also studying to be a lactation consultant which Robin has been for a while. And I have one daughter, she is 10 months old, she is almost 11 months but I’m not rounding up. It’s just going so fast, so I’m going round down till we get there.
Robin Kaplan: Go ahead Lisa.
Lisa Howe: My name is Lisa Howe, I’m 37. I’m a medical social worker and I have one daughter who is just 11 months.
Alyssa McPherson: My name is Alyssa McPherson, I’m an International Board Certified Lactation Consultant in private practice. The name of my company here in San Diego is Baby Love Lactation. I’m 43 and I have six children, five girls and one boy.
Robin Kaplan: Nice, that little boy.
Alyssa McPherson: Well, he’s 22 now.
Robin Kaplan: He’s a big one. Well, thank you ladies and welcome to the show.
[Theme Music]
Robin Kaplan: So, today we are talking about the Affordable Care Act and with us right now we have Jennifer Jordan, a proud mom of one, a breastfeeding alumni and business development associate at Aero Flow Healthcare.
So, Jennifer welcome to the show. We just want to ask you a little bit about your company and how you all are helping mamas get their breast pumps through the Affordable Care Act. So, Jennifer can you tell us a little bit about your company please?
Jennifer Jordan: Okay, great. Aero Flow Healthcare is a durable medical equipment and diagnostic testing company. We were founded 12 years ago, we were started in North Carolina. Now we actually reach throughout the south east and then well, some of our products, we have a nationwide foot print. So, that’s where it comes into play with us being able to offer breast pumps and accessories.
Robin Kaplan: So, according to the Affordable Care Act, insurance companies are suppose to provide breastfeeding mothers with a pump. How does Aero Flow assist with this process?
Jennifer Jordan: Well, Aero Flow Healthcare carry several brands of pumps. So, we work with mothers to find the best that for them. We verify their insurance, work with their physicians to get the necessary prescription because in order for insurance to cover we will need a prescription. So, we work through the whole process of locating the pump that works best for them, verifying insurance, working with the physician and then shipping the pump directly to the patient.
Robin Kaplan: So, does Aero Flow only contract with certain insurance companies?
Jennifer Jordan: We have a wide range of insurance payers we do work with. You know, we don’t always know because for example, Blue Cross, Blue Shell there is hundreds of Blue Cross plans. So, it’s really on a patient by patient basis. So, we’re more than happy to contact them, if we’re not in network, we can always work with the insurance companies towards getting in network. So, we do have a pretty wide range of insurance payers we’re able to work with.
Robin Kaplan: And what can a mother do if she has been denied the service by her insurance company? Is this something that Aero Flow can help her with?
Jennifer Jordan: Well, there is some grey area of with the Affordable Care Act. Some insurance companies we found were able to be grand fathered in and not have to actually provide all of the services that fall under the Affordable Care Act. But in most cases if they have a health plan that this coverage has started, in August of 2012, they should be covered under the Affordable Care Act.
One thing we can do is, we found out the insurance payers, there is not a lot of consistency and necessarily knowledge at the payer. So, we can call their certain medical code that are associated with breast pump and billing so that’s where we can definitely be a tool in helping the mother research and make sure they are speaking the same language as the insurance payer to see if they can get this covered.
Robin Kaplan: And what if a mother has been given a hand pump through her insurance company, but she’s going back to work and needs a double electric pump? Is this something that Aero Flow can help her to maybe negotiate with her insurance company that the need is for a higher grade pump than just a manual pump?
Jennifer Jordan: We definitely can. Most insurance payers do have a durable medical equipment benefits and that is what breast pumps fall under. And as a new mother I’m sure there has been a large amount of a deductible or portion met towards their payment, towards their insurance company. So, we can work with them to see the most affordable way and may be that they have gotten a hand pump and they also do qualify for an electric pump, because that is a different code when it comes to insurance and billing. And because they’re going back to work, our situation’s changed, we can work with them to see if they do qualify.
Robin Kaplan: And how can our listeners get more information about Aero Flow?
Jennifer Jordan: We have a website, it’s www.aeroflowinc.com A-E-R-O-F-L-O-W-I-N-C and also our toll free line, it’s 888-345-1780. And we will be happy to answer any questions and help you with this process.
Robin Kaplan: Well, thank you so much Jennifer, I really appreciate it and it’s so helpful to be able to have this perspective, not only from insurance companies but from you, from a durable medical equipment company to be able to let us know how you all are there to health facilitate this process as well.
Jennifer Jordan: Thank you.
[Theme Music]
Robin Kaplan: Today on The Boob Group we’re discussing “The Affordable Care Act” and how it covers and doesn’t cover breastfeeding support for new moms. Our experts Suzanne Madden is the COO for the National Breastfeeding Center. Thanks for joining us Suzanne and welcome to the show.
Suzanne Madden: Well, Thanks very much for having me Robin, it’s a pleasure to be here and I’m looking forward to being able to answer some of your questions about this very difficult and somewhat of a secure regulation that has gone back to the ACA.
Robin Kaplan: Absolutely. So, what does the Affordable Care Act regulation say is supposed to be covered by insurers and what are the actual benefits supposed to be?
Suzanne Madden: Well, part of the problem right now is that the Affordable Care Act, the definition of coverage was really quite vague. You should have touchdown some of the language there in your introduction. But the language simply reads that insurers must provide access to trained providers and cover the cost for renting breastfeeding equipment. And so, in terms of actual benefits from an insurer’s perspective that could really mean that their existing network or providers, physicians, nurse, practitioners etcetera are probably able to provide those services. And so, it really sort of get a little frustrated because we think of all of the great work that lactation consultants do in particularly IBCLC in a very well trained, really understand lactation can really help moms. And you look at your sort of average doctor maybe your average pediatricians that has a couple of hours, perhaps when you went to medical school to provide those services and so was that vagueness we’re actually struggling to really fully define what does that mean to provide access to trained providers.
Robin Kaplan: That makes a whole turn of sense. Because I was very curious why it’s so hard for IBCLC’s to actually get covered under this and it makes sense because it’s actually just saying trained providers. So, I appreciate you clarifying that for me. And you know because it seems to me also that not all insurance companies are even starting to cover these services and is this something that’s going to take a while, or is there certain date that the services have to be covered by?
Suzanne Madden: Yeah, that’s a great question because it does seem like some insurers are covering and some insurers are not covering and isn’t the laws supposed to be already in effect and so what’s the deal? Well, actually there is something called grandfathered plans and what that really means is that insurance companies that have benefits that may have been locked in for a period of time, say three years, don’t automatically start covering new benefits that rolls out under the ACA.
It means that they have period of time until their contracts come up for renewal. So, say you’re an employer and you bought a benefits package and you’ve locked that in for three years that was sort of price out by the underwriters and the premiums were sort of locked in to certain amount.
So, the grandfathering means that those plans are allowed to just sort of leave the benefits package as it is even though the ACA has rolled out different pieces of the law at different dates. So, once the grandfather plans actually come up for renewal, once those contracts come up for renewal then those benefits have to be covered by the insurance companies.
So, it’s really specific to the benefits that each person, each mommy, each patient actually have that is going to dictate whether you actually have those services covered or not. So, we have a huge amount of variations so even within an insurance company, even within an insurance plan, such as a PPL plan, you have all this variations depending on what the specific benefits package was that an employer purchased. So, to this sort of as I simply nail that point if you will, the ACA run into effect in August of last year. So, that’s when the benefits should have been covered. But we have this funny thing called grandfathered plans that allow the insurance companies to not cover that until their contracts come up for renewal.
Robin Kaplan: And you had mention the difference between policy and so, is this, is the ACA or the benefits that are covered for lactation, is there a possibility that someone’s policy will never include this?
Suzanne Madden: There’s a very slim possibility that it will never be included but never is a very long time. So, really what we’re seeing is sort of approaching 2014, most of this contracts are one, two and three years contracts. The three year contracts are sort of the longer term ones very rarely we’ll see a five year contract and so, there is a possibility that that would bring it up to 2017 before benefits that have to be covered by a grandfather plan. But that would be really the exception to the rule.
I think the idea here is the people need to sort of understand the right questions to ask. So, if you’re calling your insurance company and trying to find out something is covered, an insurance company might say, yes, we cover that service because the law went into effect last August. But your specific benefits don’t actually cover that because you’re on a grandfather plan. So, sort of knowing and understanding the lingo really helps to sort of understand what your specific benefits package actually is.
Robin Kaplan: Absolutely! And so getting into kind of those benefits what types of pumps are covered and say a mom is going back to work and her insurance company only wants to give her a hand pump. Can she resubmit her request?
Suzanne Madden: You know, this is again were the sort of vagueness of the language just sort of working against us. That the language in the ACA actually says, to rent pump equipment. And that’s kind of tricky because obviously pump rentals means that there has a multi user pump and you might want your own pump particularly if you’re going back to work. You know, it’s nice to sort of have your own pump be able to tow that back in work and do your own thing with it. And so, what we’ve seen is a variety of flavors, if you will, from the insurance companies.
Some will only cover a hand pump actually. They’ll say, well actually we’re not going to cover the rental of a multi user pump unless it medically necessary. And their medical necessity then maybe things like if it’s a premature baby or if there’s some sort of problem nursing like cleft palate or something like that. Then they’ll cover that sort of hospital grade multi used pump rental. But again if the insurance companies are making that very specific to medical criteria which is sort of frustrating. Others are saying, well, we will cover that price of a hand pump and you say gosh, a hand pump seriously? You’re going back to work, you might have a 10 minute break, how much milk are you actually going to be able to produce and capture in that very short time window.
And then you have other insurance companies that say we know the laws says to just cover rentals but we’re going one step further and we’re covering you for a personal pump which is great. And that’s the sort of thing that we really want to see because that what the insurance company is saying what make sense here. Pump aren’t terribly expensive piece of durable medical equipment so, just put the pumps in the hands of the moms, have that covered as part of the insurance program and really allow them to, to have, to deliver on the promise if you will of the new regulation which is about improving breastfeeding rights and duration. So particularly for moms going back to work, that makes a lot of sense. But again each insurance company is doing their own thing; there is no consistency at all across the insurance companies, across the country there is a huge variation. So, know what your specific benefits cover is really going to be the rule of thumb and figure out what’s available to you.
Robin Kaplan: Okay, fantastic! And we’re going to open up these questions to our panelists as well. Because I know two of the moms in here are working pumping moms. And so, Lisa did you receive a pump from your insurance company and what – you did get one, didn’t you?
Lisa Howe: I did.
Robin Kaplan: Yeah, was it manual or electric?
Lisa Howe: I receive an electric pump.
Robin Kaplan: Okay, how was the process?
Lisa Howe: It was very, it was very complicated, frustrating and time consuming. I started trying to get the pump from my insurance company when a couple of months before I went back to work sort of just planning ahead. So my daughter was three months old, and I spent no less than 10 phone calls. The first time I called I was transferred to multiple people who had no idea what I was talking about. Then I was told so many different things, no we can’t provide you one at all. Yes, we can, but we can only provide you this one. No, actually we can’t do that. Oh, actually you have to pay this percentage. No, you have to pay this, no you actually don’t have to pay anything at all. Everyone I spoke with had a different experience and finally what ended up happening is I got someone from my insurance company who had knew what’s going on the phone and she conference me with DME company, the Durable Medical Equipment Company and cleared things up.
But it was several weeks and many hours of work. Honestly, if you’re going to charge my hourly rate I could have bought like several pumps for the cost. But I was really determine and given I do a lot of that my professional experience as well, helping people fight insurance companies, it was the principal for me, that I knew I was due that and I wanted to get it. And so, I was able to do everything that I could. But I know that most moms, one, don’t have that information and two, aren’t able to do that. So, it’s really frustrating with, that was the process.
Robin Kaplan: Yeah. How about you Cherri?
Cherri Christiansen: Well, I’m very grateful actually in the fact that I had a very similar experience to Lisa, except Lisa went first. And I actually learnt a lot from her and I actually just, it was totally random that we have very, very similar insurance, I’m sure our plans are different but we have the same insurance provider and so, we had actually connected online and I was going through the steps I had kind of posted asking for information and Lisa had responded and so I was going through some of these steps and getting the exact same run around. So, we can do this, no, we can’t do that and then they said to me, they didn’t know what they were talking about, I had to keep calling back to find someone who was familiar with the law. I’m basically sitting there with the law – reading it to them, explaining to them what it is and what it covers. So, I’m talking to someone who knows absolutely nothing about anything.
And eventually I just decided I was just going to call the DME Company myself directly and speak to them about it. And I got the exact same spill that Lisa got which was, oh, yes we can cover you but your plan says that you can only this one model A pump, at the time I was just so grateful to get someone on the phone who said yes, you can have that pump, that I just yeah, yippy and kind of that was that. And then got off the phone spoke to Lisa I was like and I was like no, no, no. I want pump B, I don’t want pump A. And so, I actually called them back and was; now I’m on call number seven or something like that and they wouldn’t listen. So, I did the exact same thing that Lisa did. I called the insurance company, I had the insurance company called the Durable Medical Equipment Company and eventually they said to me they could get me the pump that I wanted, I would just have to pay my co-insurance which for my plan was 15% and they said that pump was back ordered and I won’t be able to get it for a couple of weeks which was fine with me.
I already had a pump and I was kind of planning ahead and getting a second one. So, but then I had to keep calling and checking and saying hey, you said it was going ship on October 24, it’s now October 27, it’s now October 31, it’s now November – like where is it? So, I think I probably had way more than 10 calls because of that. But it was so similar, it was the principle I felt like I paid for this insurance, I pay a lot, we’re talking before the show started. I pay a lot of money for my insurance and even though I owned a pump I just thought it would be really convenient to be able to have one at home and one at work and not have to do that back and forth which I still do everyday anyway. But I was just not going to give up on it and then on a side note, because I had spent so much out of pocket I actually matched my co-insurance for the year that by the time they sent me the pump I didn’t actually have to pay the 15%. So, I ended up getting covered at 100%.
Robin Kaplan: That’s terrific! Lisa had you have any experience with this?
Lisa Howe: Just this last month I became a network provider with Aetna Insurance and less than a week later I got my first phone call from a mom who had that insurance and so, we met and I did the lactation consultation and went home, called her insurance company and I’m in the process of billing right now a 100%. So, the think that I thought was interesting is that you mentioned that you had to have – you had some sort of a co-payment for this. But my understanding for this preventative services mandate with the new ACA law is that moms are supposed to be provided with these things as preventative healthcare with no co-pay or not having to meet their deductible at all. So, I’m little fuzzy about that as well.
Cherri Christiansen: It’s very, yeah, it’s very possible that I didn’t pay anything because of that. But they were just telling me that it’s because I had met my out of pocket. So, it would be interesting to see, this by the time this rolled around, this was November if I was calling in January where I hadn’t made anything, maybe it would been the same story.
Robin Kaplan: Right. Suzanne, have you heard anything about this?
Suzanne Madden: Yes, this is actually supposed to be provided at no cost and so that the whole idea of the ACA for expanding preventive women’s care is really about that being provided to you at no cost to yourself. So, the same way that you know well women visits are without no cost, no co-pay, no co-insurance, no deductible needs to be met, this is supposed to fall squarely under those preventive care services that are supposed to be provided without cost to the patient.
So, your insurance company certainly was – it was incorrect in stating that your co-insurance will apply to that. But I’m not surprised to hear it and I'm not surprised the experiences for Cherri and Lisa, as you clearly experienced every time you called the insurance company there was a different answer and part of that too is the insurers themselves really didn’t understand the law very well. And again that sort of goes back to the vagueness with which the language was sort of crafted and developed. It sort of, was so vaguely that you could drive a big truck through that hole and so the payers sort of interpreted this in a number of different ways and thought well, we can do this, or maybe we can do that. And then really getting the information out across the organization, these are huge organizations; thousands of employees in some cases particularly for national companies. And just making sure that everyone’s on the same page, that people are trained that they actually understand what the policy is internally that I think is going to really challenging for the insurance companies themselves.
So, I’m not surprised to hear that it took you a whole bunch of phone calls, things are getting better. I mean here we are in May, it’s a good about eight months or so, eight or nine months later and since the law went into effect and so, we are seeing that they are getting a little smarter and sort of more used to this. But I’m not surprised to hear that you had a variety of answers and that they were pump shortages too. I think everybody was sort of unprepared that the Durable Medical Equipment Companies weren’t prepared to meet that demand and nor were the pump manufacturers quite frankly. They didn’t really anticipate what would happen when that law went into effect last August.
Robin Kaplan: And one last question about pumps Suzanne. Is there a better time to call the insurance company to request the pump? Can a mom call or soon to be mom call before the baby is born or is it something that they have to wait until after the baby’s been born?
Suzanne Madden: It is never too early to call. And so, the language specifically says that this needs to happen during pregnancy and/or in the postpartum period. And so based obviously on the experience that we’ve just heard in, in this interview, if you have to call 10 times, if you have to keep following and you have to keep trying to get that pump, and that is still a possibility. It’s never too early to call in that case. Even if it’s just to find out what is your benefit and what are the pumps that are being offered and that’s the other piece to this. The insurance companies maybe complying with the law by actually covering some pumps, but what are the actual pumps they’re covering? Are the pumps any good? And so a lot of times there is a partnership with the Durable Medical Equipments agency or company and they may be stocking two pumps and those pumps may not actually be adequate for your needs or you may find in using them that your experiences that this pump really isn’t very efficacious for you.
And so, it’s really important I would say to find out as soon as possible. As soon as you know you’re pregnant call your insurance company, find out what your benefits are, find out what your options are and you can begin planning from there. You don’t want to wait until you’re back to, go back to work. And then is they’re delay or back order on the pump so the DME doesn’t have it or there is sort of other problem, because obviously that’s going to impact your ability to really keep nursing.
Cherri Christiansen: And this wasn’t what I was going to say, but it’s somewhat frustrating that you have to get it from the DME if it’s the same pump then you know, it seems like why can’t you just go down the street and just buy it from your local store and then submit a claim to insurance just like you would for anything else. But one thing that I thought of that I forget to mention during my process was, they actually did send paperwork to my midwife and my midwife did have to complete form showing medical necessity which confused me because I thought that I didn’t need to demonstrate medical necessity. And I don’t know if that’s related to why I got the pump that I did which was probably one of the most expensive ones that they covered. But she did have to fill out some paperwork. I never actually got the exact details from her in terms of what she said in there, because I didn’t know what they were looking for, like I would have love to have known what – I didn’t have a premature baby, we didn’t have any latch issues, someone on the phone made a clue to me, well, if you just need a pump just because you’re going back to work, you can’t have a pump just to go back to work. That’s not a medical reason, so I actually –
Robin Kaplan: I was going to say she may have put mother baby separation to be honest because that’s what I – if someone asked me what that was I would say mother baby separation.
Cherri Christiansen: And I think that’s actually what she was did end up doing. I actually need to follow up because so many people have asked me about it, but it’s just – it’s a one thing that just made me think that one piece I wouldn’t have been able to do in advance. Because if they’re requiring the reason why you need the pump, I don’t know, from me when I called I did that exact thing that Suzanne recommended was I actually called my insurance when I was about 36 weeks pregnant and this was in May, so this was before this law, I didn’t even know that this law was going to take place. To ask them what are my coverage, what are my options, if I need a pump, is it covered. I just wanted to know this information and they said, we can’t really do anything for you while you’re pregnant. And even still we would need to know, there would have to be a medical reason.
Robin Kaplan: Okay, well when we come back we’ll discuss with Suzanne the best way to get a visit with lactation consultant covered by insurance. We’ll be right back.
[Theme Music]
Robin Kaplan: Okay, welcome back to the show. We are here with Suzanne Madden, the COO of the National Breastfeeding Center and we’re talking about the Affordable Care Act.
So Suzanne, if a mom wants to see a lactation consultant, is it helpful to get that referral from her pediatrician to help it get covered?
Suzanne Madden: You know, it’s an interesting question because when we think of going to the doctor and then needing to go to see a specialist often that comes with the referral, the pediatrician sort of refers you on to that specialist. And so it sorts of logic would dictate that wouldn’t it have worked the same way to go to a lactation consultant. In terms of getting paid by an insurer though I think the answer is, no, not really. It doesn’t really help you one way or the other. It does however, allow your pediatricians to become more aware of the fact that these are needed services for moms. And it certainly helps to connect lactation consultants to pediatricians to make sure that those moms get the services they need. But what we really are sort of thinking about when we are viewing this from the insurance perspective is sort of in that working out of network, those are sort of the two key pieces here when we think this. And so, a referral from an in network doctor to say an out of network lactation consultant really have no sort of business relationship for the insurance company one or the other.
Robin Kaplan: Okay. And I know at least from by business right now, because I’m in the process of becoming an in-network provider. When a mom comes and sees me, I give her forms that can submit for herself for reimbursement but she has to pay me upfront. Are you seeing that these moms were getting reimbursed and is it the expectation do you think that lots of moms were thinking that just the LC or the lactation consultant will actually just bill for them?
Suzanne Madden: Well you know it’s funny because the moms are beginning to enquire about their benefits. Someone may hear that lactation consulting is a covered benefit for them; they automatically assume that it works the same way as it does when they go to see the doctor. And that if they see the doctor then they get co-pay or they don’t if it’s a preventive visit and the bill is handled in the backend, the providers sent it to insurance company, they exchange that information between them and the provider gets paid.
But that isn’t really the case here with lactation consultant. That only works if you’re actually an in network provider. And so you’ve mention that you are going to become an in-network provider I'm assuming with Aetna, because they are one of the few, you know insurance companies that are actually bringing lactation consultants into their network. And so, in the case of being in-network, yes, absolutely you’d be the one to submit the bill to the insurance company and then accept that payment from the insurance company. No extra cost to the actual mom. But for everybody else, that would be an out of network event and so there really is no contract, if you will, between the lactation consultant and the insurance company and therefore, no obligation for the insurance company to pay that lactation consultant directly. So, really the mom should be paying for those services upfront, getting a bill from the lactation consultant and then submitting it to their own insurance plan themselves so that they get paid back.
Robin Kaplan: One of the things I’ve notice in my own practice and, Alyssa I’m curious about yours as well. From moms who called ahead of time through for example Aetna, Cigna a couple of the other major insurance companies because there are very few or no in network providers. I have had the insurance company actually call me, have me on some list that says because there is no in-network provider in the neighborhood or within the 25 mile radius that you will now be considered someone where we will pay for our clients to come and see you and so, some of them have been approved up to six visits with me and it’s still something that I don’t actually bill the insurance company directly. But the mom submits for reimbursement but because they’ve gotten prior approval and the insurance has actually put me into their system, it’s actually worked out quite nicely for them. Alyssa, have you seen something similar?
Alyssa McPherson: Actually this mom that I saw last week when I called her insurance company they said that she was covered for the first six visits for up to 100% coverage so, and she was also provided a rental hospital grade multi user pump at no cost to her so.
Robin Kaplan: And this is also through Aetna as well?
Alyssa McPherson: Yeah.
Robin Kaplan: Aetna’s getting some big – they’re getting some high fives today.
Lisa Howe: When they cover a rental, is there a time limit on that? How long you can rent it for?
Robin Kaplan: Suzanne, do you know that?
Suzanne Madden: Yeah, that’s a great question. And again it’s to vary by each insurance company. But we typically see that, that would – that is often covered for the first year. Now, obviously the law hasn’t been in effect for the first year, but reading through some of the insurance companies actual policies and some of these are available, if you call and available online, if you do a search. But some of those policies will actually indicate that for the first year.
We have seen one or two others that actually say for the duration of the breastfeeding period. So, if you go further than that first twelve months certainly some insurance companies were covered, but again the variation is the problem, the devils in the details. And each insurance company is doing it differently. I would just like to say part of the work that we do at the National Breastfeeding Center is to try and help get some of this consistency across the plan. And so, we’ve actually drafted a model policy that really talks about what services should be covered, how this should actually be paid and the same with the pumps. What pumps should covered? What is actually appropriate? What types of pumps? Now, not list manufacturers but to actually say, what are some of the features that these pumps should have that would in fact make them sort of the most appropriate, most efficient and effective pumps in the market place and then how to actually get those? That point was raised earlier about having to go through DME companies.
Well, if you need a pump, you need that pump today, right. You don’t need that pump you know three months from now or two months from now when the back logs are through when the DME can ship it to you. Even if they have it in stock you’re looking at three or four days. In some cases there is a real necessity to have that pump in your hands more quickly. So, we firmly believe that providers and that would be physicians and IBCLCs and various other parties should in fact be able to provide that pump directly to moms. Get it in the hands of the moms when they actually need that service and that equipment.
So, we are hoping for some consistency, over the next several months as we sort of roll out this model policy and really identify for the insurance companies, this is what the spirit of the law actually is. This is what you really need to be doing if you in fact do want to support improving breastfeeding rights and duration of breastfeeding across the country.
Robin Kaplan: Ladies, Lisa and Cherri, I don’t know if you guys saw lactation consultants, but if you did, did your insurance company pay for you to see them?
Cherri Christiansen: All the lactation services that I got before August 1. Yeah, so unfortunately I didn’t even bother trying to go back, I didn’t think it – I figured if the law went into effect there I wasn’t going to be able to anything retroactively so, I didn’t even try with that.
Robin Kaplan: How about you Lisa?
Lisa Howe: All of these services that I received were also before August 1, but I submitted anyways and was denied and I’m appealing it. I personally appeal anything, the insurance company says no to and I have about 90% rate of being reimbursed so.
Cherri Christiansen: I do have one question, not for me but I often run into other moms and tell them about my experience and how I got a pump covered and they – I didn’t know I could do that or can I still do that and so my question is, is there a limit? If you’re – I don’t know how we define that postpartum period. But if you have a six month old baby or a 10 month old baby, you never got a pump, can you still do that? What’s the limit?
Suzanne Madden: You know, we have seen some insurance companies actually define that as 90 days post birth and again that’s really sort of frustrating because we’re like well, what if a mom is on maternity leave and doing great and has been nursing away and then sort of realizes late, I’m going to be going back to work soon, perhaps they have six months maternity leave and they need a pump for going back to work. What happens then, well they might have missed that 90 window? And so again, this is sort of why we were trying to create this consistency across payers because you really want to be able to deliver on the promise of the ACA, we really want to be able to see that moms have access to pumps and services as they need them when they need them. Not when the insurance company sort of says that you can have them. You know either there’s support for breastfeeding or there’s nonsupport for breastfeeding.
And so, we were really sort of pushing through this in a real open access of services and equipments for moms because there is so many different variations every mom’s experience is different and unique quite frankly. So let’s make sure that we can support moms in the way they need to be supported, not in the way that some sort of very dry and bureaucratic policy says they need to be supported.
Robin Kaplan: And Suzanne, we’ve been really just talking private insurance, but what about government insisted insurance like, medicate, medical, all of those, are they included under this, are they going to get this assistance as well because I’ve heard they have a really tough time getting pumps and lactations services covered?
Suzanne Madden: There really has been a hard time getting things covered, part of that too is because the WAKE is always sort of there and available to help moms. But we have a really exciting program that’s actually just rolled out in New York State. We’re really thrilled, in fact with what they’re doing. New York State is probably the first one to offer this through medicate that they will actually pay for lactation counseling services and the sort of qualified practitioners that will get reimbursed by medicate are in fact IBCLCs. So, you need to be either a physician, a nurse practitioner, a midwife, a physician assistant or registered nurse. The idea here is that it’s you’re either a license registered or certified healthcare professional. And you also have to have IBCLC designation. If you have those two things then New York State medicate will actually cover those lactation counseling services.
Robin Kaplan: That’s fantastic!
Suzanne Madden: They’re also covering pumps, yeah and they are also covering pumps too and in fact have some very specific minimum requirement for pump specification, so we are absolutely thrilled to see that medicate in New York State had sort of gone one step further to actually define what’s a good quality pump. What’s actually going to be a pump that’s going to in fact, help to ensure that women can continue their nursing efforts, when they are relaying on a pump to be able to express.
Robin Kaplan: That’s so exciting too because really all you need is just one state to take the reins and run with it. I’m surprised it wasn’t California because I have to say we usually do some pretty cool stuff here but. That’s wonderful because then all we have to do is just follow suit so.
Suzanne Madden: And that’s what so remarkable about it and the fact that it is such a high quality program. That’s what really thrilling about it it’s not just that they’re saying okay, we’re going to cover some services for our already participating physicians or nurse practitioners, they really have focus out quite extensively and identified very clearly IBCLCs and identified very clearly appropriate types of pumps. So, we’re really hoping that other states will just, utterly take on board the exact same sort of policies that the New York State has rolled out.
Robin Kaplan: Wonderful. Well, thank you so much Suzanne for sharing your incredibly valuable information about the Affordable Care Act and which it’s guidelines states should be covered for breastfeeding support. And for our Boob Group Club members our conversation will continue after the end of the show as Suzanne will discuss her top three tips for having a breast pump and visit with an IBCLC covered by your insurance company. For more information about our Boob Group Club please visit our website at www.theboobgroup.com.
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Robin Kaplan: So, here’s a question for one of our experts, this is from Jennifer and she was asking Joanna Clark, one of our sleep experts and here is what she wrote. “Hi Boob Group experts, I have a question. My four month old has stopped sleeping consistently. One night he will sleep six hours in a row and then the next he will only sleep two. I’ve tried everything I can think of, burping more before I put him down for the night and burping less, putting him down earlier and putting him down later, laying him down flat and laying him down slightly reclined. Sometimes he demands to nurse each time he wakes and other times he’s happy just being rocked a little bit and he’s back to sleep. It feels like nothing I do makes a difference in the long run as far as sleep patterns go. Will he ever start giving me more consistent sleep? This mama really needs it, thanks”.
Joanna Clark: Hi! Jennifer, this Joanna Clark, a blissful baby sleep coaching talking to you about your four month old baby and your child’s new sleep issues. Yes, four to five months old babies tend to have a lot of sleep disruption. This is typically known as the four to five month old sleep regression time period. And the reason why this happens is that babies in this age group are going through massive of physical and cognitive developments. And their melatonin and cortisol levels which are the two hormones that regulate sleep are making massive shifts and yes, you will find that babies will start having more partial arousals at night approximately every three to four hours.
So, the question is what to do? Well, the first thing to do is to look at your child’s sleep expectations for that particular age group, four to five months. A baby that young is still doing a lot of daytime sleep, in fact they are doing four to five hours of day time sleep spread between three to four naps and I always encourage moms with these newborns to give whatever it takes to get a nap so if you want to nurse them, rock them, stroll them, bottle feed them, wear them, drive them, whatever you need to do to try to get as close to four to five hours of daytime sleep spread between three, four naps will start to really, really, really help minimize the partial arousals at night.
And also, it is still common to do lots of nursing or bottle feeding at night and regarding your concerns about how much to feed, I always recommend to moms to connect with the pediatrician or their lactation consultant to actually come up with a night time feeding plan based on child’s age and development. The best thing to do is just recognize that all these physical and cognitive development is normal, it is going to be causing some sleep disturbances and what you can do is just allow your child to start practicing some of those new skills during the day especially rolling, is a big one that causes some sleep disturbances so right before any kind of physical development usually comes, those sleep disruptions and allowing them to practice a new skill during the day could help speed up that process.
So, I always recommend moms during this challenging phase to really just integrate a great bed time routine, focus on getting your great daytime sleep, anyway you can get it and divide on your night time nursing plan and all the other waking where you’ve decided not to nurse or bottle feed, find other ways to comfort your baby back to sleep and it should move through this process pretty gracefully come out on the other side. Thanks a lot and I hope that everything goes well.
Robin Kaplan: That wraps up our show for today, we appreciate you listening to the Boob Group, don’t forget to check out our sister show Preggie Pals’ for Expecting Parents and our show Parent Savers for Moms and Dads with Newborns, Infants and Toddlers.
Coming up next week, we have Anney, Jen and Cherri discussing what life is like, what life has been like breastfeeding their ten to eleven month old in our series Breastfeeding Expectations. Thanks for listening to the boob group, your judgment free breastfeeding resource.
[Disclaimer]
This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are believed to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.
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