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The Catalyst

Affordable Care Act mandates no charge breast pumps for new mothers

By Christine M. Green
Office of Strategic Planning

A Medela Breast pump.

With the implementation of the Affordable Care Act and health care reform underway, there are several new benefits available to patients at no cost under most health insurance plans including the ACA–compliant MUSC Health Plan.

One of these benefits provides for breast-feeding equipment to be made available at no cost for pregnant and postpartum women, as well as comprehensive lactation support and counseling from trained providers for the duration of breast–feeding.

According to the Centers for Disease Control and Prevention, breast–feeding is one of the most effective preventive measures mothers can take to protect their health and that of their children. Historically, one of the barriers to doing so has been the cost of purchasing or renting a breast pump.

As a designated Baby–Friendly hospital, MUSC encourages mothers to begin breast-feeding before an infant is an hour old. This global initiative, launched by the World Health Organization and UNICEF, promotes specific steps related to mother and baby bonding as well as successful infant feeding.

According to Sarah Taylor, M.D., Department of Pediatrics, for normal development an infant should be breast– fed exclusively for the first six months and then continue with supplementation from other food sources for at least a year. Any variation to this pattern raises health risk, she said

“In our current society with many mothers working, breast pumps enable more mothers to express milk and for longer. If infants receive mother’s milk for at least 6 months even compared to infants who receive mother’s milk for four months, infants have significantly lower risk of infections. Also, infants have lower odds of SIDS (Sudden Infant Death Syndrome), leukemia, diabetes, and leukemia with any breast–feeding.”

Using a breast pump helps the mother as well. “Mothers also receive health benefits from breast–feeding with a decreased risk of ovarian and breast cancer and lower odds of hypertension, hyperlipidemia, and cardiovascular disease. Therefore, health is optimized for mother and infant with breast–feeding for at least six months if not longer,” said Taylor.

MUSC encourages breast-feeding and there is a great deal of support from physicians, nurses, and lactation consultants, said Vicki Marsi, Women’s Care service line administrator. "We're thrilled that coverage for breast pumps is included in the Affordable Care Act as it encourages mothers to breast–feed and provides them with access to the tools they'll need for optimal success, such as lactation support and a quality breast pump,” said Marsi.

While the ACA calls for health plans to cover the cost of a breast pump, it does not provide a clear definition of the type of equipment women should receive. Instead, insurance providers have been left with decisions involving what type of breast pumps to recommend and how much of the cost they will reimburse. Until the federal government provides greater specificity regarding what types of breast pumps must be provided, coverage will vary among insurance carriers.

Delivering a Baby at MUSC
When an expectant employee or spouse covered by the MUSC Health Plan delivers at MUSC, Blue Cross Blue Shield has agreed to cover $150 toward the cost of a breast pump. However, they will only pay $80 for those who deliver elsewhere. Although the ACA enables adult children to stay on their parents’ health insurance plans until age 26, maternity benefits are not extended to dependents who become pregnant.

Aeroflow Inc., the durable medical equipment provider designated under the MUSC Health Plan, offers the Medela Pump In Style Advanced Starter set for $150 and this pump will be fully covered under the plan. Employees will not have to pay the cost of the pump in advance or submit for reimbursement to BlueCross BlueShield. The only out–of–pocket cost for the pump will be the $25 shipping cost which is paid to Aeroflow Inc. Employees also will be responsible for paying the costs of additional supplies needed to pump and safely store breast milk for their babies.
Items such as storage bags, coolers and bottles are not included with the pump.

If an employee chooses to select an upgraded breast pump, she will pay the difference between the maximum allowable amount (either $150 or $80) and the more expensive model, in addition to the shipping fee, directly to Aeroflow Inc.

To order a breast pump, visit the Aeroflow Inc. website (www.breastpumps.aeroflowinc.com) and select the “Qualify Through Insurance” tab at the top of the webpage. Complete the form and submit via the Internet. The employee will receive a confirmation e-mail outlining the next steps and an Aeroflow Inc. representative will contact her within three business days. Prior to being contacted by an Aeroflow Inc. representative, employees should review model styles on the Aeroflow Inc. website.

April 3, 2014
 
 
 

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