Too often, families have been denied the benefit of comprehensive breastfeeding and lactation support. This despite the fact that the Affordable Care Act requires it, with no co-pay, deductible or cost to families. Recently a class action settlement was reached that addressed this very issue.

The CareFirst class action suit was filed in October of 2016 for families whose claims were denied. This December 2018, it was announced that a $3.6 million class action settlement has been reached. The settlement was with HealthMark. Nicholas Chimicles, the plaintiff attorney, described this as an “excellent result”.

Two other lawsuits are pending with United Healthcare and Health Care Service Corporation.

Marsha Walker, RN, IBCLC and a board member of MLCA, was able to provide a good deal of information to the lawyers litigating this class action lawsuit. “This is such great news.” she said. “Hopefully, the other insurers involved will also receive this as a wake up call.”

Insurance company responses to the ACA have varied widely. Aetna does provide coverage with in-network IBCLC lactation consultants. Other health plan companies will reimburse for the cost of an IBCLC home visit. Some continue to deny claims for families who paid for lactation support.

It is important that health care providers and health plans understand the value of IBCLC care and include lactation specialists, IBCLCs, in their network. In our experience, many administrators do not realize the necessity of continuing care beyond the hospital. They are also unclear about the varied levels of breastfeeding support that are available. MLCA along with USLCA continues to have discussions with insurance providers.

This class action suit is a firm step forward.

Click here for more Information from the National Women’s Law Center about health plan violations of the Affordable Care Act.