Is Breast Milk Covered by Health Insurance?
In the end, none of the letters mattered. Tricare's review board upheld the initial denial. The reason, according to a six-page letter: "The requested service is not a covered benefit" and "is included on the No Government Pay Code listing as unproven. ... Any drug, device, medical treatment, or procedure whose safety and efficacy has not been established is unproven and is excluded from coverage."
Though Tricare's decision may seem misguided, it's not unusual for insurance companies to refuse coverage for donor milk. Yet a 2003 study published in the Journal of Perinatology determined that every dollar spent on donor milk for premature infants can yield $11 to $37 in cost savings, because those infants require less medical treatment.
Last year this principle helped lead Duke University to start offering donor milk to all preemies in its hospital system who aren't receiving their own mother's milk. It has also influenced the National Business Group on Health, a nonprofit organization that recommends healthcare policy for large corporations. In its 2007 publication "Investing in Maternal and Child Health," the group recommends that companies cover up to $2,500 in donor milk per infant, reasoning that babies who get breast milk cost the healthcare system less than formula-fed infants. According to a 1999 study in the journal Pediatrics, when researchers compared 1,000 babies who were exclusively breastfed for at least their first three months to 1,000 who were never breastfed, the latter logged 2,033 more office visits and 609 more prescriptions for ear infections and gastrointestinal and respiratory tract illnesses during their first year of life.
If you'd like to help make donor milk more affordable and accessible, Pauline Sakamoto, president of HMBANA, suggests these steps:
- Ask your employer or insurer to provide coverage for donor milk.
- Spread the word. Talk to your medical providers about donor milk.
- Support the U.S. Breastfeeding Committee in helping shape federal policy on donor milk programs. Go to USBreastfeeding.org to learn how.
- Support the establishment of clean, private places for mothers to pump at work. The more women nurse and pump, the greater the possible supply of donor milk.