Mothers battling insurers for breast pumps, despite new law

April 9, 2013

Photo: Flickr/planet_oleary

By Hannah Guzik
California Health Report

When Adriana Stovall heard that the Affordable Care Act would require health insurance companies to provide nursing mothers with a breast pump beginning Jan. 1, she was elated.

Finally, the working mother would have access to an efficient pump, enabling her to provide more milk for her 11-month-old son.

Or so she thought.

Stovall is among a number of California nursing mothers who have had their requests for a breast pump denied by their insurance companies this year, despite the new law.

“They said that I wasn’t eligible for a pump because my son was almost 1 and he didn’t have a medical ailment, so it wasn’t necessary for him to receive breast milk, when formula was available,” the Ventura resident said. “That was very alarming to me.

“Breast milk has so many benefits to mother and child, and they’re just hindering the whole reason this act was put into place.”

The Affordable Care Act requires insurers to provide new mothers with a breast pump, but it doesn’t specify what kind of pump or how long after giving birth women can qualify. So, in the last three months, insurance companies have begun creating their own policies, with some providing high-end electric pumps to all women who ask and others offering only manual pumps to women in the first 30 days postpartum on a rental basis.

Stovall’s insurance provider, Kaiser Permanente, offers manual pumps only to women who have given birth in the last six months, and rents hospital-grade pumps to those with a medical need, the company said in a statement.

Peggy Hinz, spokeswoman for Kaiser’s Southern California region, declined to comment on specifics of Stovall’s request or the company’s policy.

“While we are prohibited from discussing the details of a specific patient, Kaiser Permanente follows all aspects of the Affordable Care Act including those pertaining to the coverage of preventative services,” she said in an email message. “This includes support for breast feeding equipment to our members.”

“Should a specific member have any concerns we encourage them to reach out to their OB/GYN or to member services at any time,” Hinz said.

The federal law is intended in part to expand health-care services for women and provide them with more preventative care and access to lactation support and supplies.

“Breastfeeding is one of the most effective preventive measures mothers can take to protect their health and that of their children,” reads a fact sheet on the coverage from the federal Department of Health and Human Services. “One of the barriers for breastfeeding is the cost of purchasing or renting breast pumps and nursing related supplies.”

Difficulties obtaining a pump could cause some mothers to stop breastfeeding, especially if they need to return to work and aren’t able to afford a pump out-of-pocket, said Paris Maloof-Bury, a lactation consultant and registered nurse who runs a support group for breastfeeding mothers in Ventura.

“My feeling is that without being able to maintain their (breast-milk) supply with a good pump while at work, they may not be able to have enough milk at home either for their baby,” she said.

Manual pumps cost about $30, but the more efficient electric pumps — which Maloof-Bury recommends for nursing mothers who work full-time — typically cost between $150 and $400.

Stovall, who works full-time as an administrative assistant, said she couldn’t afford to buy a new pump when hers began malfunctioning during her son’s first year, and she suffered health problems as a result, including plugged milk ducts and mastitis, a breast infection.

In mid-January, her doctor wrote her a prescription for a pump, and put in a request to her insurance company, under the new law. Nearly a month went by, and she heard nothing from Kaiser, Stovall said.

“I had to call them to find out I’d been denied,” she said. “The fact that they just didn’t get back to me and explain to me from the very beginning their policy just seemed shady. It seemed like they didn’t care and it wasn’t a priority for them.”

Stovall was eventually able to get her malfunctioning pump replaced through the manufacturer, but if that hadn’t been an option, she might have thrown in the towel, she said. She now intends to breastfeed her son until he is at least 2, as per the World Health Organization’s recommendations.

“It don’t think it’s fair for insurance companies to say, ‘You’re away from your son for 10 hours a day, but we can’t give you a pump because of his age,’” she said. “That was almost like a slap in the face for me. I wanted to ask them, ‘Do you have any children and did you formula feed them?’”

Some mothers of newborns have also reported difficulties obtaining breast pumps through the health care law.

Weshoyot Alvitre, also of Ventura, got a prescription for a pump in late January, when her daughter was 2 months old. But when she tried to fill it at medical supply stores in the area that contract with her insurance company, Anthem Blue Cross, they told her they didn’t have pumps in stock or had just created new guidelines that required mothers to be less than 30-days postpartum to receive one, she said.

“It’s frustrating, because there are boxes and boxes of these things on store shelves, so I really don’t believe them when they say they have a ‘shortage,’” Alvitre said in an email message.

Alvitre, who works as a store artist for Trader Joe’s, eventually decided to buy a manual pump herself, spending about $40. She added her name to a waiting list for a pump from a medical supply company, but has yet to hear back, she said.

Darrel Ng, spokesman for Anthem Blue Cross, said he couldn’t comment on Alvitre’s case or the company’s policy regarding issuing breast pumps, because the person who handles those issues was out of the office.

Ng did say that health insurance companies have reported “a nationwide shortage on these, just because when the benefit came out they weren’t ready for the demand.

“I don’t know that we have a warehouse full of breast pumps,” he added. “We process claims, we’re not like Amazon and we just have these things in a warehouse somewhere.”

Other new mothers, including Oxnard resident Valerie Lopez, have had success obtaining pumps after initially being denied by their insurers.

“A couple days after being denied over the phone, I got a letter saying I was approved,” she said. “I said, ‘You’re kidding me, but I’ll take it.’ I drove on my lunch break that day to pick it up.”

Insurance companies are still establishing their policies and weighing whether they meet the requirements of the new law, Maloof-Bury said.

“Gaining compliance, with any big change, requires time and emotional buy-ins,” she said. “As insurance companies learn more about the long-term cost-benefits to them if a baby is breastfed, I think getting pumps will be easier.

“All that mothers want to do is feed their babies. They’re not asking for anything extreme. It’s a very basic human right.”