Fighting Insurance Discrimination Against Mothers:
Your Right to Access Lactation Counseling, Support, and Services

As many people now know, the Affordable Care Act (ACA) requires private insurers and employer plans to cover a broad array of preventive health care services without cost-sharing.  This means you and your family can get your immunizations, cancer screenings, and birth control for no additional costs.  What’s more, insurers must cover comprehensive lactation support and counseling from a trained provider before and after each birth.  Insurers must also cover the cost of a breast pump.

Unfortunately, pregnant and postpartum women around the country have learned the hard way that many major insurers have been failing to deliver on this important protection.  Specifically, insurers are failing to provide in-network access to the trained lactation support providers required under the law and are denying claims when women are forced to seek services from out-of-network providers.  As a result, women must either pay for the out-of-network cost of these services themselves — which average $120-$350 per session — or, if they can’t afford that, forego the services completely.

In response, women have begun to bring class action lawsuits against their insurance companies, including UnitedHealthcare and CareFirst (a licensee of the Blue Cross Blue Shield Association operating in the Mid-Atlantic).  The lawsuits cover women enrolled in either individual or employer-sponsored health plans, although the specific claims vary depending on the type of coverage.

The CareFirst lawsuit has already settled and class members can submit claims to get reimbursement for their out-of-pocket costs.  CareFirst also agreed to take several steps to expand its network of lactation providers and otherwise improve coverage of and access to these services.  The UnitedHealthcare case remains in active litigation.

You may have faced unlawful barriers to accessing lactation services or other benefits required under the ACA if you have experienced any of the following:

• Your insurer has told you that it does not have in-network lactation counselors or other lactation support service providers;
• Your insurer refuses to provide you with a list of in-network lactation counselors or other lactation support service providers;
• Your insurer has denied a claim that you submitted after seeing an in-network lactation counselor or other lactation support service provider; or
• Your insurer has denied a claim that you submitted after seeing an out-of-network lactation counselor because there were no in-network counselors available in your area.

If any of these apply to you, contact Mehri & Skalet today to explore your legal options.