Recently, USLCA’s President, Debi Ferrarello, MSN, MS, RN, IBCLC, RLC spoke with an attorney from the firm planning to launch a class action law suit on behalf of women who have been denied coverage for lactation counseling under the Affordable Care Act (ACA). Debi reports that the attorney was well aware that IBCLCs are the optimal providers of these services. The attorney had researched the number of IBCLCs in the United States and made the case that women who are denied coverage may turn to formula because they don’t get the help they need from qualified individuals. The attorney also mentioned the impact of this disruption in covered services on the business of the IBCLC. The attorney acknowledged that many insurance companies refer mothers to physicians or nurses who are not qualified to provide lactation consultation, or deny claims to out-of-network providers when they, in fact, have no in-network providers.
When asked why her firm was pursuing this lawsuit, the attorney explained to Debi that they are a class action lawsuit practice that has been focusing on the ACA for several years. The attorney cited the Women’s Law Project work, highlighting the fact that insurance companies are non-compliant with multiple facets of the ACA. Debi referred her to the National Breastfeeding Center’s Model Policy for Insurance Companies.
The Board of USLCA wants you to know about this upcoming case because as IBCLCs, we know that all families deserve access to the care of an IBCLC and that the ACA gives them the right to access our expert services. We know that as IBCLCs, most of us are connected with the families who might choose to opt-in to this class action suit. We recognize the difficulty that IBCLCs face when seeking reimbursement from insurance companies and that it significantly impacts their business model and, in some cases, creates a situation in which they can no longer remain in practice. This is an important step in realizing our vision of a nation in which all families have access to IBCLC care as a foundation of optimal health and wellness.
I’ve had an awful time with my insurance in the last four months. Is there someone I can talk to about making sure they answer for their awful handling of the situation?
Thanks Laura,
I’m sorry to hear about the trouble you’ve experienced. I’ve sent you a separate email with some information about how you can reach out to the law firm filing this class action lawsuit.
Cheryl I have multiple clients with this issue and want to forward the information.
Thanks Serena,
I’ve sent you a separate email with the information as well.
You can contact the law firm and read more about the complaints filed here: https://www.chimicles.com/breastfeeding-support-and-supplies-coverage-under-the-aca-as-a-preventive-service
This is great news! It’s a shame that there has to be an intervention requiring insurance companies to do the right things, especially since the financial benefits for THEM are well documented. As a community based provider, I too am seeing these same issues over and over, especially denial of ANY coverage for any support, not just IBCLC. Kudos to the attorneys for taking on this case.
Will the class action lawsuit be collecting stories? Our practice ran into significant difficulty with a particular insurance company when contracted with them. Now we are no longer contracted with this payor, but they continue to deny and downcode patient superbills for patients from our practice. We have about 2-5 calls per day from some of the members of these insurance plans who choose not to get help because it is out of pocket for them. Our practice sees 600+ families a year in the Pheonix Metro area.
By the way, I’m excited about this news! Something has to be done about this flagrant disregard for ACA compliance at the expense of the health of women and children.
Thank you, Desiree. Please contact the law firm via this link: https://www.chimicles.com/breastfeeding-support-and-supplies-coverage-under-the-aca-as-a-preventive-service
I hope that this helps to improve families’ access to the expertise of IBCLC care!
Debi Ferrarello, MSN, MS, RN, IBCLC
President, USLCA