Healthcare Insurers Graded on Support for Breastfeeding Moms: Emblem Stands Above the Rest with an A+

New York, November 3, 2014: Emblem receives the highest grade out of 106 healthcare insurance plans nationally ranked by the National Breastfeeding Center (NBfC) on the provision of breastfeeding benefits to those insurers’ members. Research was initially conducted in 2013 to see how the insurance industry was responding to the Patient Protection and Affordable Health Care Act (PPACA), which went into effect on August 1, 2012, and has been refreshed to see how these policies have changed in the year since their first scoring.

“We are two years into this benefit provision now,” says Susanne Madden, COO, of the National Breastfeeding Center, “and we wanted to see if insurers were doing a better job of meeting the intent of the law.” Madden went on to say, “We still see insurers that only provide the bare minimum required by law, such as a manual hand-operated breastpump and advice given during a well care exam by providers that may have little lactation care experience, but overall the results show that the trend is toward improvement, in many cases significantly.”

“This year we also added in a new measure for assessing if insurers were covering the cost of premature babies receiving donor human milk,” says Beverly Curtis, the Executive Director of NBfC. “While we only found that benefit in a handful of policies, we thought it significant enough to warrant inclusion. Our hope is that insurers will begin to more fully utilize the Model Payer Policy (released last year in conjunction with the USBC) in an effort to better understand coverage needs and ways to see a return on those investments in better population health in the future.”

Madden said that Emblem topped the list this year “primarily because they aligned their benefits with the New York State Department of Health’s comprehensive breastfeeding recommendations. Furthermore, they fully support the use of qualified, trained lactation consultants rather than relying on its existing network of physicians, most of whom have no understanding of lactation issues.” Companies covering home visits, offering a variety of pumps that are able to be dispensed from both providers and medical supply companies, and utilizing trained consultants are the ones that scored highest.

“Companies should see our score card as a helpful tool for evaluating their breastfeeding support policies,” Curtis says, “and like Emblem, Aetna and Anthem, aspire to be the best in this critical area of mother and infant healthcare insurance coverage.”

NBfC assessed commercial insurance companies’ published policies and guidelines and assigned a grade based on the adequacy of coverage provided. Using The Verden Group’s Policy Search tool to locate official Medical Policies, Google to search insurers’ member and public domains for guidelines, and newsletters that contained information about each company’s breastfeeding coverage, “we’re confident we’ve conducted a comprehensive review of the information available,” says Madden.

That review also included talking to trained lactation consultants, who are specifically referenced as the providers required by the law to be paid. “We were very disappointed to hear how difficult it is for trained consultants to be paid for rendering these services,” said Madden. “We viewed two United Healthcare policies that actually conflict with one another, making payment to lactation providers impossible. As a result, we have had to downgrade United’s score from A- to a D until this issue is resolved.” The issue is that their payment policy specifically prevents payment of the most frequently used lactation codes from being paid to non-licensed providers. However, there is no licensure for lactation consultants available.

Why grade insurance companies on their breastfeeding support policies at all?   “The purpose of the law is to improve breastfeeding initiation and duration rates,” Curtis replies. “It follows that mothers should receive lactation counseling support from a provider educated in lactation care.” Madden agrees and says “This year we dug further than ever into assessing these benefits,” Madden concludes, “and we want insurers to do even better going forward.”

View the 2014 Scorecard here

Download a pdf of this release here.

Questions? Please reach us here: inquiry@nbfcenter.com / 855-777-NBFC

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McCaskill Bill would require Tricare to cover breast-feeding expenses

From ‘the Military Times’ By Patricia Kime, Staff writer

Tricare would cover the cost of breast-feeding equipment, support and counseling for new moms who want to nurse their babies under a bill introduced by Sen. Claire McCaskill, D-Mo.

The Affordable Care Act requires insurers to cover the full cost of renting or providing pumps as well as lactation counseling and support. But Tricare pays only for efficient, hospital-quality breast pumps for use in medical facilities and under some conditions for premature infants.

“As someone who was a single, working mother, I know firsthand the importance of comprehensive, affordable health care when caring for a new child,” McCaskill said in a statement. “New mothers in the military and military spouses deserve access to the services consistent with coverage available in the private sector.”

McCaskill said she plans to move quickly to secure bill co-sponsors and reach out to Democratic and Republican lawmakers for support.

Her bill, S 1994, drew quick praise from the National Military Family Association, an advocacy group representing military dependents, retirees and families.

“Ensuring that military health care benefits are on par with civilian coverage is one of our top priorities,” NMFA officials said.

As the military’s health program, Tricare was not pulled into the legislative orbit of the Affordable Care Act, an omission that for the most part has shielded military beneficiaries from some of the negative consequences of the law, including dropped insurance and rate hikes.

But several disparities, including breast-feeding supply coverage, exist.

At least one difference between Tricare and the ACA was rectified shortly after the law was signed, when Congress approved health care coverage for unmarried children of military personnel and retirees up to age 26, as also required by the ACA, under a new option called Tricare Young Adult.

But even that change has met with opposition from some military sponsors who object to the fact that TYA, available to beneficiaries ages 21 to 26, requires enrollment and payment of monthly premiums.

Rep. Sam Graves, R-Mo., introduced a bill Jan. 30 that would allow dependent youths to stay on ordinary Tricare Prime or Standard, like their parents, until age 26, instead of requiring them to enroll in TYA.

Graves proposes to pay for his bill by trimming foreign aid “like green energy programs in Africa or climate change initiatives in Asia.”

His proposed bill, HR 3974, has been referred to the House Armed Services Committee. Graves has yet to attract any co-sponsors.

http://www.militarytimes.com/article/20140205/NEWS/302050030/Bill-would-require-Tricare-cover-breast-feeding-expenses

Status

Healthcare Insurers Graded on Support for Breastfeeding Moms – Anthem and Aetna Score Highly!

NBfC_Breastfeeding-Policy-Scorecard-09.2013

National Breastfeeding Center has released a scorecard of healthcare insurance companies based on coverage policies for breastfeeding support.

Anthem and Aetna both score highly out of 100 healthcare insurance companies graded by the National Breastfeeding Center (NBfC). Research was conducted to see how the insurance industry is responding to the Patient Protection and Affordable Health Care Act (PPACA), specifically the part of the law concerning coverage of breastfeeding support, a provision which went into effect on August 1, 2012.

“It has been a year since the mandate went into effect,” says Susanne Madden, COO, of the National Breastfeeding Center, “so there has been plenty of time for insurers to adjust to the law. We wanted to see how insurance companies are performing when it comes to supporting nursing mothers and their babies.”  Madden says that the NBfC research uncovered a wide range of insurance company policies and compliance.   “We were encouraged to find that some insurers really recognize the importance of improving breastfeeding and support the intent of the mandate by covering fully qualified lactation care providers and effective breastfeeding equipment.  But many more provide only the bare minimum required by law, such as a manual hand-operated breastpump and advice given during a well care exam by providers that may have little lactation care experience.”

“We weren’t surprised to see Aetna near the top of the score card,” says Beverly Curtis, the Executive Director of NBfC.  Aetna was quick to open its network to lactation care providers who have certification as International Board Certified Lactation Consultants (a designation awarded by an independently-accredited program). Curtis points out, “it is important that insurance companies support care delivered by independently certified professionals as these are the providers best qualified to address and improve lactation care.”

Madden said that the Anthem Group of companies came to the top of the list due to such provisions as covering home visits and allowing pumps to be dispensed from both providers and medical supply companies.  “Companies should see our score card as a helpful tool for evaluating their breastfeeding support policies,” Curtis says, “and like Aetna and Anthem, aspire to be the best in this critical area of mother and infant healthcare insurance coverage.”

NBfC assessed commercial insurance companies’ published policies and guidelines and assigned a grade based on the adequacy of coverage provided. Using The Verden Group’s Policy Search tool to locate official Medical Policies and Google to search insurers’ member and public domains for guidelines and newsletters that contained information about each company’s breastfeeding coverage, “we believe we’ve conducted a comprehensive review of the information available,” says Madden.

Why grade insurance companies on their breastfeeding support policies at all?   “The purpose of the mandate is to improve breastfeeding initiation and duration rates,” Curtis replies.  “It follows that mothers should receive lactation counseling support from a provider educated in lactation care.” Madden agrees and says “It’s the best way to insure that the care provided is appropriate to each mother’s concern or issue and that each has access to breast pumps that perform appropriately according to her medical or societal needs. Insurers are now tasked with making sure that happens, and that healthcare dollars are spent more wisely and invested in preventive care. To do less than their best for their littlest members is simply not good enough. We want to bring attention to that,” Madden concludes, “and prompt insurers to do even better going forward.”

Questions? Please reach us here: inquiry@nbfcenter.com / 855-777-NBFC