Julie had planned to breastfeed, but Gabriel was too weak to nurse, she was too sick to pump, and in any case, her medications would have tainted her milk.
Then the nurses told John, "You know, there's a mothers' milk bank in Austin."
John had never heard of milk banks, but once he learned that donors are screened and that their milk is pasteurized, he got a prescription (all 11 of the banks in the Human Milk Banking Association of North America require a prescription in order to dispense milk). During the seven weeks Gabriel remained hospitalized in Texas, he received milk from the Austin bank. In August, when Gabriel was cleared to go home, John arranged to start getting milk from WakeMed Mothers' Milk Bank in Raleigh, North Carolina, which serves the East Coast.
The package that arrived on the Montemurnos' front porch the day after they got home—containing 480 ounces of frozen breast milk, including milk supplied by Lynn Page—was enough to feed Gabriel for two weeks. It cost $1,559.75, which Julie and John charged to their credit card. WakeMed and the other HMBANA banks are nonprofits, and are not in the habit of giving away milk; though the mothers who supply them aren't paid, screening donors and collecting, processing, and shipping milk is costly. However, WakeMed offers a 30 percent discount to families who pay in full within 30 days. Julie and John took advantage of that deal.
The Montemurnos aren't wealthy. He is a navy lieutenant; she, a stay-at-home mom. From the first, they'd hoped to be reimbursed for the milk. They had a letter from one of the doctors who'd attended Gabriel in the intensive care unit, listing nine diagnoses (ranging from anemia of prematurity to suspected sepsis to risk for necrotizing enterocolitis, a condition that strikes mostly preemies and causes portions of the intestines to die), and concluding, "...it is imperative that he receive donor breast milk, since Mrs. Montemurno is unable to breastfeed." But Tricare—the healthcare program that insures members of the military and their families—denied coverage.
John and Julie submitted an appeal, with more letters of support. One doctor pointed out that for ill or preterm infants, "human milk is not just nutrition; it is a vital medicine" (preterm infants fed human milk have a lower risk for sepsis and necrotizing enterocolitis, and spend fewer days in the hospital). Another was more blunt: "After practicing for 32 years, I am still not able to understand the thought processes insurance companies use. ... [T]he decision not to cover the cost of donor breast milk for this family [is] one of the most illogical I have ever encountered."
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.