Problems with Insurance and Breastfeeding Benefits

What to Do if You Get Stuck with a Breastfeeding Benefit Issue

Breast Pump
Photo © Jamie Grill/Getty Images

One of the many benefits that women are excited about when it comes to the Affordable Care Act (ACA) is many benefits around breastfeeding. Here is how HRSA talks about the benefits for women: “Comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum period, and costs for renting breastfeeding equipment… in conjunction with each birth.”

The National Women’s Law Center (NWLC) has found that at least 20 insurance companies are not providing the services that they should be providing and are in violation of the law.

Some of the violations included limiting the coverage of breast pump purchases and having no lactation consultants in network. They also found other issues such as limiting the timeline for lactation services to the two months after giving birth, or forcing a mother to wait to get a breast pump until after the birth of her baby. These are some similar stories to those that I have heard in my practice.

“Denying women certain breastfeeding benefits is a clear violation of the law, and women are experiencing the consequences every day,” said Gretchen Borchelt, NWLC Vice President for Health and Reproductive Rights. “The Affordable Care Act has made dramatic improvements in women’s health coverage. If insurance companies fail to comply, they are illegally blocking further progress toward helping women breastfeed successfully. Everyone involved, from insurance companies to federal regulators, must work together to ensure that breastfeeding coverage fulfills the promise of the ACA.”  

So what do you do if you feel like your rights have been violated or that your insurance company isn’t upholding their end of the deal? Your first step is to send a letter. The NWLC offers samples within their tool kit. This also explains what should be covered according to the ACA.

One of the problems I see with letter writing is that it’s great before you need the services, but typically if you need to see a lactation consultant, you need to see one immediately.

My advice is to talk to the lactation consultants in your area. The chances are that they have already dealt with this issue. They may be able to give you a specific person to whom you should speak, or help you find a fast resolution. 

In the meantime, Anna Benoyo, senior health policy analyst and one of the authors of the study said, “We are asking that the federal agencies that oversee this benefit engage with stakeholders—including breastfeeding experts—so that officials can better understand how important timely access is to establishing breastfeeding.”

 NWLC also collected information on women’s experiences using their breastfeeding benefits through the organization’s CoverHer nationwide hotline (1-866-745-5487 or  

In addition to these steps, it is important that women complain to their state insurance commissioner. National Association of Insurance Commissioners (NAIC) has links to each state’s regulator. 

Some of the stories that I have heard in my practice include one mother who kept being told that she would have to call from the hospital to order a breast pump.

Of course, there were delays when she called and her pump did not arrive until her maternity leave was half over and when it arrived it was missing parts.

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