Insurers Begin Covering Breast Pumps, Lactation Counseling Under Affordable Care Act Provision

January 7, 2013 — More women are beginning to take advantage of a provision in the Affordable Care Act (PL 111-148) that requires health plans to cover breast pumps or lactation consultations without out-of-pocket costs, the Washington Post 's "Wonkblog" reports. For many individuals, the provision took effect when their health plans renewed on Jan. 1.

However, insurers, providers and consumers have run into problems with implementing the provision. Health plan administrators, who have little or no experience with the benefits, have questions about how they can comply with the provision, "Wonkblog" reports. No state has ever required private insurers to cover breast pumps at no-cost, but 31 states require Medicaid to do so.

Matthew Stearns, a spokesperson for UnitedHealthcare, said his company has decided to give women the option of renting a hospital-grade pump or purchasing a less-expensive personal pump. By contrast, Blue Shield of California has said it will only cover rentals.

Insurers also are hitting roadblocks in attempting to recruit lactation consultants to join their networks. Diana West, who works for a New Jersey lactation consulting business, said that "a very big obstacle" for consultants is insurers are offering reimbursements that are much lower than what they currently charge for consultations.

In addition, some women are having problems obtaining pumps, even if their health plan includes the coverage.

Leila Abolfazli, a senior counsel at the National Women's Law Center who gave birth a few months ago, said even though her health plan confirmed that she did not have to pay a copayment for a pump, it required that she obtain the pump through a medical supplier. However, she was unable to find one that had pumps available and had contracted with the health plan (Kliff, "Wonkblog," Washington Post, 1/4).