Anthem slashes reimbursement for breast pumps

Anthem Inc., one of the state’s largest insurers, has cut reimbursement for breast pumps, igniting fears about whether mothers will have access to adequate equipment that works for them at no extra cost.

In April, Indianapolis-based Anthem started paying suppliers less for breast pumps that are sold to mothers throughout Anthem’s entire 14-state footprint. Anthem would not disclose how much they now pay for pumps, but a breast pump maker said it’s at least a 36 percent cut in reimbursement, to $95 from about $150.

With the passage of the Affordable Care Act, expectant mothers were able to get a breast pump at no additional cost to them. The law requires insurers to cover pumps, which was a major win for women who previously paid out of pocket for the devices, which can retail for hundreds of dollars.

“It was very exciting, and I think it definitely helped a lot of women who couldn’t afford a breast pump to continue to nurse so they could return to work,” said Sierra Cortazzo, owner of Kangaroo Kids, a retail outlet for newborns and mothers on Manchester Road in St. Louis. Cortazzo also is a lactation counselor.

A breast pump is a medical device that uses a motor to extract milk from a woman’s breasts. It’s an important tool, particularly for working mothers who are separated from their newborn for hours at a time. Typically a woman needs to pump multiple times a day, or as often as the baby eats, to maintain an adequate milk supply.

While the Affordable Care Act requires that at least some breast pumps are covered at no cost to mothers, it does not stipulate what kind of pump must be covered. And Anthem’s new reimbursement policy does not ensure that every pump is available at no cost, just a certain tier.

Anthem maintains that mothers will still have access to double-electric breast pumps at no cost, which include popular models such as the Medela Pump in Style.

For mothers who want access to a pump outside of Anthem’s fully covered list, mothers will have to pay out of pocket. And for mothers who need access to hospital-grade pumps, Anthem said, they will be provided if it’s deemed medically necessary and when she meets certain criteria.

“Anthem recognizes the positive health benefits that breastfeeding can have on mothers and their newborns, and we are committed to ensuring new mothers have the information, tools and support they need to successfully breastfeed their newborns,” according to an email statement provided by spokesman Scott Golden.

With the change in reimbursement, however, some are worried that mothers will be forced to use products that don’t work for them, which will ultimately discourage them from breastfeeding.

Breastfeeding has immediate and long-term health benefits for babies, but mothers face many barriers to breastfeeding, some of which the ACA tried to address in 2010.

During the month a mother returns to work she is twice as likely to quit breastfeeding as nonworking mothers, according to one 2011 report in the American Journal of Public Health.

A lack of privacy and time to pump at work are major reasons why new mothers quit breastfeeding, the study says.

The ACA carved out protections for breastfeeding women in the workplace.

The law requires employers to provide “a place, other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public, which may be used by an employee to express breast milk,” the law states.

Prior to the ACA, there were virtually no federal protections for breastfeeding mothers at work, according to the study.

A study in Maine of the effect of the pumping provision showed a dramatic increase in insurance claims for pumps among privately insured women.

The number of claims for breast pumps among women with private insurance increased to 803 claims during the third quarter of 2012 from 70 claims during the same period two years later, according to the study of Maine’s insurance claims.

However, low-income women who qualified for Medicaid in Maine did not experience the same increase in claims. Women with Medicaid in Maine had only 11 claims throughout the entire study period from 2012 to 2014.

The pumps are not covered by Maine’s Medicaid program, according to a 2017 study in the American Journal of Public Health.

Nearly half of all births in the U.S. are paid for by Medicaid, the state-run insurance for eligible low-income individuals.

“The lower-income moms don’t have the ability to make that purchase, so they’re in a spot where they get that basic pump,” said Amy O’Malley, director of education and clinical services for Medela, a pump maker.

Alexandra Rankin, government affairs manager for Missouri Foundation for Health, echoed concerns about access. “It’s also really concerning for women of color, who traditionally have lower rates of breastfeeding,” Rankin said.

Babyation, a St. Louis startup, is releasing a new pump later this year that allows a mother to pump discreetly and quietly, a vast departure from the more traditional pumps.

“To me the question is: Don’t women deserve innovation?” asked Sam Rudolph, Babyation’s CEO and founder.

“Breast pumps are not an option, it’s a necessity,” Rudolph said of new mothers. They deserve to be able to “revolve their breastfeeding around their life instead of the other way around.”

Anthem’s change in reimbursement comes on the heels of other controversial payment decisions made by Anthem within the last year.

In 2017, Anthem warned patients they could be on the hook for an entire emergency room bill if they sought care for what the company deemed as minor ailments. Anthem also said it would no longer pay for imaging tests done at hospital-owned facilities, citing enormous cost differences.

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