Breast Pump Insurance Reimbursement: What’s In It For Mothers
Irene Murphy Zoppi, RN, MSN, IBCLC / November 2018
Were you aware that on April 1, 2018, Anthem Blue Cross/BlueShield decreased reimbursement rates for breast pumps by 45%, from $169 to $95? Anthem is a large independent licensee of Blue Cross/Blue Shield that insures about one-third of individuals and families in the United States.
Alarmed by the impact of not being able to secure quality breast pumps for mothers, and the real consequences that many mothers may stop breastfeeding, multiple organizations including the United States Breastfeeding Committee, state breastfeeding coalitions, and advocacy groups have submitted letters to Anthem petitioning them to reconsider their reimbursement rate change (view Medela’s response).
Breastfeeding duration and exclusivity have improved over the last several years since implementation of the Patient Protection and Affordable Care Act (ACA), with statistically significant increases in breastfeeding duration by 10 percent, and exclusive breastfeeding by 21 percent from 2012 to 2014.1
In another report, Kapinos et al demonstrated access to the mandated breastfeeding services and supplies protected by the ACA increased the probability of breastfeeding initiation by 2.5 percentage points, translating into about 47,000 more infants who began breastfeeding.2 Access to quality breastfeeding supplies such as breast pumps may be a strong contributing factor to these recent gains.
Impact to breastfeeding
Anthem executives argue that breast pump access will continue. But all breast pumps are not equal. They differ in technology, motor type, and in pump strength and durability. All these factors influence how well they remove milk from the breast, or can cause pain. Inevitably, the mother’s milk supply may decrease and cut short her breastfeeding experience.
In a blog post for new pumping mothers, Preparing to Pump: A Guide to Breast Pumping for New Mothers, September 25, 2018, the Anthem guidelines state, “Regardless of which pump you decide to choose, it is imperative that you select the right size of breast shield, which is the funnel-shaped part that fits over the breast. Failure to do so can lead to extreme discomfort.” Not all pump manufacturers provide a range of breast shields with their pumps that accommodate the many size needs of mothers. Having an incorrectly fitted breast shield may first hinder milk removal, and second cause nipple tissue pain and/or trauma.
Why this reimbursement change matters
In a recent submission to the Journal of the American Medical Association,1 three economists presented implications regarding Anthem’s decision to decrease the rate of reimbursement for breast pumps. Previously, the authors concluded that a decrease in reimbursement rates challenged breastfeeding, access to quality breast pump products, and threatened advances made with breastfeeding initiation and continuation in the United States.
Citing the monthly cost savings data compiled by Bartick and Reinhold4 by infant disease in 2018 U.S. dollars, the authors presented three case scenarios that demonstrated Anthem would not save money but rather would endure increased costs. In all presented scenarios, the authors calculated Anthem would lose money if breastfeeding was discontinued five days, one week, or two weeks earlier than intended. The increased costs resulted from increased infant health care costs associated with suboptimal breastfeeding.
We need to support breastfeeding mothers
Mothers need additional breastfeeding support, not barriers, to continue to breastfeed. Mothers should feel comfort in knowing their ability to meet their breastfeeding goals is supported, and not hindered. Reducing reimbursement for breast pumps may result in decreased access to quality products. If a breast pump does not meet the needs of the mother, does not contain research-based technology, and takes longer to use, many mothers may stop breastfeeding.
The dichotomy by making access to breast pumps increasingly difficult is that insurance companies may not save money at all. These costs will then be passed onto insurance companies and ultimately to the insured. Breast feeding rates may decline, while health care expenditures for documented childhood illnesses are likely to increase.
Have the mothers you worked with had trouble accessing quality breastfeeding support and supplies? Share your stories in the comments below. We’d like to hear from you.
Read more on this subject: Statement from Medela US Managing Director, Melissa Gonzales
- Gurley-Calvez, Bullinger and Kapinos. Effect of the Affordable Care Act on Breastfeeding Outcomes. Am J Public Health. 2018, 108(2):277-83.
- Kapinos KA, Bullinger L, Gurley-Calvez T. The Affordable Care Act, breastfeeding, and breast pump health insurance coverage. JAMA, published online Sept 10, 2018.
- Kapinos KA, Bullinger L, & Gurley-Calvez T. Lactation support services and breastfeeding initiation: evidence from the affordable care act. Health Services Report. 2017, 52(6):2175-96.
- Bartick M, Reinhold A. The burden of suboptimal breastfeeding in the United States: a pediatric cost analysis. Pediatrics. 2010, 125(5):e1048-e1056.
About the Author
Irene joined Medela in 1999 as a clinician for the Breastfeeding Division. She currently serves as a Clinical Education Specialist focusing on Advocacy Outreach. In this role, she acts as a vital resource for groups assisting breastfeeding mothers and infants. She has been frequently interviewed on radio and online regarding breastfeeding issues for mothers and clinicians.
Irene spent many years caring for new families in antenatal, labor and delivery, postpartum and NICU settings and was involved in direct patient care and family-based education. Irene has extensive experience teaching in a variety of nursing education programs. She produced a video presentation on nursing students’ involvement in Community Health Nursing for the National League of Nursing.