Alabama Assists Other States to Address Breast Pump Reimbursement Issues
In late December, durable medical equipment providers received a letter from Anthem informing them of a reduction in reimbursement for E0603, from $169.15 to $95.00. The effective date is April 1, 2018.
Anthem Inc. (Often just called “Blue Cross” or in New York “Empire”) insures tens and tens of millions of people in the following states. This has a nationwide impact and there are some other areas in other states that may be missing from the following list of states: CA, CO, CT, GA, IN, KY, ME, MO, NH, NV, IL, NY, OH, VA, WI.
Many mothers will not realize this change in reimbursement has occurred until it is too late.
The same issue was faced in Alabama in late 2016, involving Blue Cross/Blue Shield of Alabama. The reimbursement fee of $95, was found to be unacceptable by most IBCLCs. Since only the most very basic pumps could be purchased for this amount, professionals feared that first time breastfeeding mothers would soon become frustrated with the inadequacy of the pump provided and cease to breastfeed for this reason.
The Alabama Breastfeeding Committee (ABC) wrote a letter expressing these concerns to the Blue Cross/Blue Shield Medical Director and included prices for pumps that were most recommended by mothers. The recommended reimbursement for an adequate pump was $150. ABC members also started a social media campaign and before long, Facebook posts were being seen throughout the state. It was communicated to BCBS that if mothers complained about the pumps available for this price, they would have to be told that this was these were the only pumps provided by their insurance. After further negotiations, BCBS retracted their previous recommendation and announced that the new reimbursement would be $150.
Anthem is not making a big public announcement about the barriers they are throwing up around breastfeeding. Instead, they are going about it quietly through changes that they announce only to their networked providers, denials of claims for hospital grade pumps, low reimbursement rates for hospital grade pumps and a dearth of recommendations for referrals of in network lactation consultants who can support mothers. The latest act, the announced reduction of fee schedule, was sent as individual letters to every DME provider who holds a contract with Anthem.
In effect, this means that Anthem is publicly stating that they support high value and quality care through all of their messaging on their website and their recognition of what’s called “Blue Distinction Maternity Care Facilities”, but the cold reality is that they are slowly eroding any quality support that a mother would really need to support the provision of breast milk for her baby. The latest move – the rate drop – is slated to take effect on April 1. With the appropriate outcry from the public, we, in Alabama, know that other states can turn this around. To this end, we are trying to raise awareness.
It is recommended that coalitions in the affected states email the Chief Medical Officer, Craig Samitt. (Craig.Samitt@anthem.com), and have supporters post on their social media feeds and on well-read mom/ baby sites so that the awareness gets raised. (@antheminc). For more information, contact Gayle Whatley, Alabama Breastfeeding Committee at firstname.lastname@example.org.