03/21/2024
12 years after the passage of the Affordable Care Act, I am still fighting for insurance companies to pay for preventive breastfeeding help. Today I filed reconsiderations for about 10 claims from Cigna where they either applied it to deductible or assigned a co-pay. This is what I put as my reason.
"Under § 1001 of the Patient Protection and Affordable Care Act (ACA), which amends § 2713 of the Public Health Services Act, all non-grandfathered group health plans and health insurance issuers offering group or individual coverage shall provide coverage of women’s preventive services starting after Aug. 1, 2012 to include “comprehensive lactation support and counseling and costs of renting or purchasing breastfeeding equipment [] for the duration of breastfeeding”. Cigna has not established in-network lactation counseling, as required by federal law. Federal guidance on the preventive services clarify that, “… if a plan or issuer does not have in its network a provider who can provide the particular service, then the plan or issuer must cover the item or service when performed by an out-of-network provider and not impose cost-sharing with respect to the item or service.”
Thanks to the Affordable Care Act (ACA), most health insurance plans must cover all FDA-approved, cleared, or granted birth control – and related services – and other important preventive health care needs, including breastfeeding supplies, lactation consultations, and well-woman visits. Use our...
