Reading about successful class action suits is encouraging. Though before it comes to a lawsuit, calls and letters can make a difference. Some insurance companies have recognized the value of IBCLC care sooner than later. Here’s an example.In November 2016, administrators from Blue Cross/Blue Shield of Massachusetts had a phone meeting with members of MLCA. We explained the lactation process and IBCLC care. Those administrators came to understand why mothers would need support beyond the hospital. In January of 2017, Blue Cross/Blue Shield began reimbursing for IBCLC home visits.Many more families were able to get breastfeeding support. This included Partners employees who had Blue Cross/Blue Shield. In January 2019, however, some Partners employees with Blue Cross/Blue Shield were switched to the newly created AllWays Health Care.Unfortunately, when the switch was made, this lactation benefit was not included. This was distressing to families. In one case, a mother was assured by Blue Cross/Blue Shield in December 2018 that IBCLC home visits were reimbursable. Yet when her twins were born in early 2019, she learned that her AllWays plan would only cover office visits.This policy change was three big steps backwards. The new mother made several calls to AllWays. Other families also complained to the Human Resources department and the Commissioner of Insurance. Phone calls were made, Maire MacLean and Smita Oke were especially persistent in contacting AllWays. A MLCA representative spoke with an AllWays representative at a State House event.Thankfully, this education about IBCLC care resulted in positive action. AllWays explained:
“Effective for dates of service 05/01/19 and later; lactation consultant services in the home are covered; no prior authorization is required. Lactation consultant services are preventive benefits that are available to the lactating mother for the duration of the breastfeeding period. Preventive benefits apply no cost sharing on HMO plans or in-network on PPO plans. ASO plans may elect to include this service. Lactation consultant services are not covered for My Care Family members."*
We’re glad that the response from AllWays was productive. It remains a problem that families with the My Care Family plan (the MassHealth plan) still do not receive this benefit. Medicaid plans usually require licensure for coverage or reimbursement.We continue to advocate for licensure of the IBCLC, to make this level of care accessible to all families… and especially to solve the disparity in access to health care services.Are you an IBCLC or know a breastfeeding family with AllWays? Let us know what your experiences have been. Let your insurance company and legislators know, too. Every call or letter is an education for people who make these policies and can make a difference.You can send an email toaccesscommittee@masslca.org orinfo@masslca.org*a statement from ALLWays benefits committee shared with MLCA access committee.
