In August of 2011, HHS and the Obama Administration announced that the Affordable Care Act (P.L. 111-148) would require that insured women would receive specified preventative health services at no additional cost to the patient. The list of services to be provided included:
- well-woman visits;
- screening for gestational diabetes;
- human papillomavirus (HPV) DNA testing for women 30 years and older;
- sexually-transmitted infection counseling;
- human immunodeficiency virus (HIV) screening and counseling;
- FDA-approved contraception methods and contraceptive counseling;
- breastfeeding support, supplies, and counseling; and
- domestic violence screening and counseling.
According to HHS Secretary Kathleen Sebelius, “These historic guidelines are based on science and existing literature and will help ensure women get the preventive health benefits they need.” These benefits went into effect for all insurance policies beginning on or after August 1, 2012. While much media attention has been given to the ongoing battle regarding the “FDA-approved contraception” requirement, another issue has begun to arise across the country—a shortage of breast pumps for nursing mothers.
Although the preventative services requirement went into effect for policies issued or renewed after August 1, 2012, an individual coverage date is dependent upon when the plan plan rolled over and began again. For many policy holders, this date was January 1, 2013. Insurance companies have all taken a different route to meet the requirement. Some companies are providing rentals free of charge, others are only supplying less-expensive manual pumps. Providers that only supply manual pumps have drawn criticism, as these pumps are relatively inexpensive (approximately $30) and not sufficient for working mothers when compared to electric pumps, which run from $150 to $300. The HHS guidelines merely state that plans must provide: “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.
However, many providers are covering the cost of more expensive electric pumps, and the Washington Post reports that this has led to a shortage of pumps across the country. Breast pump manufacture Hygeia notes that one cause of the shortage is that Durable Medical Equipment (DME) suppliers were not given any advance information about what was going to be covered from insurance providers, and therefore were stripped of the ability to prepare for the increased demand. They have stated:
It’s a complex problem. First, the Affordable Care Act language isn’t specific enough about what exactly insurance companies need to cover and how the breast pumps would be covered. The vague wording left the insurance companies to determine what they would provide to their members. Because each insurance company must balance a controlled cost environment while following the law, each insurance company had to interpret the law individually. The DME providers could not be sure what was going to be covered by each insurance company, so they couldn’t forecast what would be needed.
The ACA went into effect on August 1st, 2012, but only for plans that renewed after that date. Because so many plans renewed on January 1st, and so little information was available on what those plans were going to cover before that date, DMEs couldn’t predict the market. Without any market forecasting, they were unable to communicate any future needs to the manufacturers. DMEs cannot legally bill an insurance company until they deliver a product or service to the mom, so on January 1st, total chaos erupted as over 1,000 moms called DMEs each day.
- See more here.
Fit Pregnancy notes that moms facing the shortage currently have three options— waiting for their insurance company or DME provider to restock, purchasing their own pump, or seeking out local rental options. With this sudden uptick in purchasing and renting, the FDA recently updated its information for consumers on breast pumps, their purchase/rental, and proper cleaning and use. In response to the shortage, Edgepark Medical Supplies, a national DME supplier, was reported to have stopped taking orders for pumps due to the shortage. They are now taking orders again and have begun providing detailed information for consumers on their website to assist them with the process. Some pump manufacturers are taking a different route all together- Hygeia is currently offering a$150 coupon for consumers who were denied coverage of a pump or were unable to obtain one through a medical supply company.