Tell IL Dept of Insurance to provide guidance to fairly implement ACA breastfeeding requirements
This petition had 1,612 supporters
The Affordable Care Act's expansion of women's preventative services includes comprehensive breastfeeding support, supplies, and counseling. This is a completely new benefit, applying only to non-grandfathered health care plans, that involves providers and equipment not previously included in the healthcare setting. Because of this, guidance from state and federal agencies is needed to implement the requirements uniformly and comprehensively.
... Mothers in Illinois report they are often not able to obtain a list of in-network providers of lactation support from their insurance companies. They report being told to go see their OBs or baby’s pediatricians, who are not trained providers of comprehensive breastfeeding support or counseling, for breastfeeding help. They report being told by their insurance companies that lactation coverage is limited to the inpatient setting. They report being charged co-payments for services or supplies if they are able to obtain reimbursement. They report their plan will only reimburse for a manual breast pump, or they will not be reimbursed for the rental of an additional hospital-grade breast pump when a baby is in the NICU. They report their claims are denied, even when other women in their offices with the exact same insurance coverage have their claims paid. These reports from IL mothers are echoed at the national level in a recent report from the National Women’s Law Center which documents violations to the ACA.
To address disparities and violations with implementation of the breastfeeding requirements of women's preventative services in Illinois, we are asking the Illinois Department of Insurance to issue a bulletin that:
- Requires insurance carriers to establish a sufficient network of lactation service providers that can provide comprehensive breastfeeding support so women can obtain timely in-network lactation services at no cost-sharing, within a reasonable distance;
- Clarifies that until an insurance carrier establishes a sufficient network of lactation providers, women must be able to obtain this service out-of-network, as required by law;
- Clarifies that lactation services, as a part of preventative services for women, must be covered at no cost-sharing;
- Clarifies that reimbursements are in conjunction with each birth and for the duration of breastfeeding; and
- Provides guidance to indicate coverage limited to a manual pump is insufficient and that there are instances when the rental of an additional hospital-grade pump may be medically indicated, as determined by a health care professional.
Add your signature and share your story of trying to obtain reimbursement from your insurance company for comprehensive breastfeeding support or supplies in Illinois with the DOI.
1) Insurers must establish a "network that is sufficient in number and types of providers ... to assure that all services will be accessible without unreasonable delay" - see eCFR §156.230
2) Until a sufficient network is established, out-of-network claims must be covered free of costsharing. - see DOL FAQ Part XII, Question 3
3) Women's preventative services are covered at no costsharing, and the requirement is "comprehensive lactation support and counseling" "in conjunction with each birth" - see HRSA's Women's Preventative Services Guidelines
4) Eligibility is for "the duration of breastfeeding" - see DOL's FAQ Part XII, Question 20
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