Cut in reimbursement for breast milk pumps worries some moms
BRANFORD, Conn. (AP) — If not for the breast milk pump Akimi Nelken received when her daughter, Margaret, was born last July, Nelken might have had to give up on breastfeeding.
“We had a lot of issues at the beginning with breastfeeding,” Nelken said. “She had trouble latching on at the beginning.”
The pain caused by Margaret’s latch, which was too shallow, brought on post-partum depression and lack of sleep for her mother. Nelken used her pump to keep Margaret fed and to keep up her milk supply.
“If I hadn’t been able to take that break, I probably would have quit,” said Nelken, an English teacher at Wilbur Cross High School in New Haven. Her husband, Ben Nelken, teaches English at Cooperative Arts and Humanities High School.
“It’s more the case that breastfeeding is difficult for women at first than that it is easy and natural,” Nelken said. Now back at work, she pumps four to five times a day.
Breast milk pumps, and other breastfeeding supports, have been a no-cost health benefit since the Affordable Care Act — Obamacare — was passed in 2010. But mothers such as Nelken and breastfeeding advocates are concerned a cut in the rate Anthem Blue Cross Blue Shield Connecticut will pay for breast milk pumps will mean mothers will receive lower-quality equipment.
As of April 1, Anthem will reduce its reimbursement rate for breast milk pumps by 44 percent, from $169.15 to $95, according to the Connecticut Breastfeeding Coalition.
Sarah Yeager, an Anthem spokeswoman, said the company does not disclose the rates it pays for medications or medical equipment, but that the reduction is in the negotiated rate the insurer pays the durable medical equipment companies that supply the pumps.
However, Yeager said the quality of pumps Anthem offers will not decline. “It doesn’t impact the member . It’s with our contracted medical supplier,” Yeager said.
Anthem issued a statement saying, “Anthem recognizes the positive health benefits that breastfeeding can have on mothers and their newborns.” The company said the brands it offers include Ameda Finesse, Evenflo Advanced, Lansinoh Signature Pro, Spectra S2 Plus and Medela Pump In Style.
“The pumps that are listed . are considered the Cadillac of breastfeeding pumps,” Yeager said.
Nelken said she uses the Medela Pump In Style Advanced. Kate Schrami, a spokeswoman for Medela, said the only difference between the Pump in Style and the Advanced brands was that the former is specifically for the insurance market and has different features, such as a different number of bottles or storage bags.
“It’s the same product but it’s named differently,” she said. “The technology in the product is exactly the same.” Schrami said the double-phase technology used in both pumps, which more closely mimics a nursing baby, was patented by Medela.
Yeager stressed that mothers need to get a prescription from their doctor and order the pump through Anthem-contracted companies. If bought retail, Anthem will only reimburse $95. Pump In Style Advanced retails for $299.99 and up, according to Medela’s website.
Meredith Young, a physician assistant and lactation consultant at Yale New Haven Children’s Hospital, said, “I would be super happy if that is true . I just don’t know any of the DME’s (durable medical equipment companies) that actually do that.”
Young said she hopes Medela and other companies will maintain the same quality in the pumps they manufacture but past experience makes her wary. “When Obamacare first went into effect and insurance was going to pay for pumps, that’s when Medela made the single-phase” model that was offered through insurance plans. Medela discontinued the single-phase pump in 2015, Young said.
Young said she is concerned that “by cutting the reimbursement rates, that limits the pumps that are available to new moms and we’re worried that it will reduce the quality of pumps. It can affect their whole breastfeeding journey. In the past there have been some companies that limit the type of pump a mom can get.” Once one insurer cuts its rate, others will try to follow, she said.
Young said that using a more efficient pump is important because “the more milk you get out, then the more milk you make.”
Breast milk pumps are important for women who have trouble nursing naturally or who work and must leave their babies for hours at a time, Young said. “It’s not just that breastfeeding is great; it’s a public health concern,” she said, reducing ear, respiratory and gastrointestinal infections, allergic reactions and sudden infant death syndrome.
“The really scary ones that I think about are obesity,” which decreases 15 percent to 30 percent when a baby is breastfed, and diabetes. It even reduces the chance of childhood leukemia and lymphoma by 20 percent, Young said.
A serious threat for formula-fed babies is necrotizing enterocolitis, an infection in which part of the intestine dies. “For those babies, the breast milk is medicine, really,” she said.
Another important reason to have high-quality pumps available is for premature babies or others who start out in the neonatal intensive-care unit and can’t breastfeed as often as needed or at all.
For mothers, breastfeeding appears to protect against ovarian and breast cancer, as well as high blood pressure, diabetes and high cholesterol, which lead to heart disease.
“Why would you cut something that in the end the insurance companies are going to have to pay more (for)?” Young said.
Nelken said she hopes to nurse Margaret at least through her first year, possibly until age 2, and she plans to place her daughter in day care in August. “I know I’ll want to continue breastfeeding when she goes to day care because there will be a lot more germs,” she said.
Nelken said of her baby, “She’s never been to the pediatrician except on well visits. She has my entire immune system working for her. Since I haven’t been sick, she hasn’t been sick.”