Breastfeeding not medically necessary

So says my insurance company, having rejected a claim from a specialist
at the Faulkner Breast Centre who tried a procedure to open my milk
pores to enable me to breastfeed my newborn four months ago.

I am outraged and helpless.

Hi --

Escalate! If the insurance company fails to give satisfaction, your
next step is your state's overseer of medical insurance companies. If
THAT fails then I'd start writing to newspapers, etc, but hopefully this
will succeed at the state level.

Be sure to include, in your missive to the state commissioner (or
whatever) information about health benefits to mother and child.

Good luck,
--Beth Kevles

http://web.mit.edu/kevles/www/nomilk.html -- a page for the milk-allergic
Disclaimer: Nothing in this message should be construed as medical
advice. Please consult with your own medical practicioner.

NOTE: No email is read at my MIT address. Use the AOL one if you would
like me to reply.

Good for them! They should stop wasting money on fertility treatments as
well.


"Lady Penelope Creighton-Ward" wrote in message
oups.com...
So says my insurance company, having rejected a claim from a specialist
at the Faulkner Breast Centre who tried a procedure to open my milk
pores to enable me to breastfeed my newborn four months ago.

I am outraged and helpless.




Inviato da X-Privat.Org - Registrazione gratuita http://www.x-privat.org/join.php

Beth Kevles wrote:
Hi --

Escalate! If the insurance company fails to give satisfaction, your
next step is your state's overseer of medical insurance companies. If
THAT fails then I'd start writing to newspapers, etc, but hopefully this
will succeed at the state level.

Be sure to include, in your missive to the state commissioner (or
whatever) information about health benefits to mother and child.

Good luck,
--Beth Kevles

http://web.mit.edu/kevles/www/nomilk.html -- a page for the milk-allergic
Disclaimer: Nothing in this message should be construed as medical
advice. Please consult with your own medical practicioner.

NOTE: No email is read at my MIT address. Use the AOL one if you would
like me to reply.

Seconding the escalate comment. Ask to speak with your insurance
ombudsman, and ask them, very very clearly to state why this claim was
being rejected as 'not medically necessary.' Write down what they say,
and if necessary repeat it back to them to ensure that you understand.
If questioned, say that you need to be clear on this for your follow-up
with the attorney general's office.

If they're a managed care entity, there are specific DOI laws (well,
not laws, but conditions they need to meet in order to sell in MA --
for example, the 48 hour minimum stay) that also encompass encouraging
breastfeeding. Just FYI.

Boston Medical has a breastfeeding center with LCs who advise re.
insurance issues.

Another source is:

Massachusetts Office of the Attorney General, Insurance Hotline
888-830-6277
508-792-7600/New Bedford
508-990-9700/Worcester
617-727-0434 (TDD)
413-784-1200/Springfield
www.ago.state.ma.us

Grrrr...Best of luck -- keep us posted.

Caledonia

hmmm, now, your case was very unusual, it may be worth trying to find out if
they fund lactation consultants, breast pumps, that kind of thing, and if
they do, who, all babies, just prem babies, sick babies etc. Just get as
much info as possible. The others who are more familiar with the US system
have given you helpful advice to push your case forwards, it would seem that
having this kind of information as justification could help.

How are you getting on these days, I know you were gutted over these
problems, how is you baby doing?

Cheers

Anne

Caledonia wrote:
Beth Kevles wrote:
Hi --

Escalate! If the insurance company fails to give satisfaction, your
next step is your state's overseer of medical insurance companies. If
THAT fails then I'd start writing to newspapers, etc, but hopefully this
will succeed at the state level.

Be sure to include, in your missive to the state commissioner (or
whatever) information about health benefits to mother and child.

Good luck,
--Beth Kevles

http://web.mit.edu/kevles/www/nomilk.html -- a page for the milk-allergic
Disclaimer: Nothing in this message should be construed as medical
advice. Please consult with your own medical practicioner.

NOTE: No email is read at my MIT address. Use the AOL one if you would
like me to reply.

Seconding the escalate comment. Ask to speak with your insurance
ombudsman, and ask them, very very clearly to state why this claim was
being rejected as 'not medically necessary.' Write down what they say,
and if necessary repeat it back to them to ensure that you understand.
If questioned, say that you need to be clear on this for your follow-up
with the attorney general's office.

If they're a managed care entity, there are specific DOI laws (well,
not laws, but conditions they need to meet in order to sell in MA --
for example, the 48 hour minimum stay) that also encompass encouraging
breastfeeding. Just FYI.

Boston Medical has a breastfeeding center with LCs who advise re.
insurance issues.

Another source is:

Massachusetts Office of the Attorney General, Insurance Hotline
888-830-6277
508-792-7600/New Bedford
508-990-9700/Worcester
617-727-0434 (TDD)
413-784-1200/Springfield
www.ago.state.ma.us

Grrrr...Best of luck -- keep us posted.

Caledonia

Thank you so much for this extremely helpful information. I've been on
the phone all day. Got lots of phone numbers from the National
Women's Health Information Center, U.S. Department of Health and
Human Services, Office on Women's Health, but so far none have
produced any useful results. I've left lots of messages and am also
looking into the option of getting pro-bono attorney services - I have
to find out first if I'm eligible.

Anne Rogers wrote:
hmmm, now, your case was very unusual, it may be worth trying to find out if
they fund lactation consultants, breast pumps, that kind of thing, and if
they do, who, all babies, just prem babies, sick babies etc. Just get as
much info as possible. The others who are more familiar with the US system
have given you helpful advice to push your case forwards, it would seem that
having this kind of information as justification could help.

How are you getting on these days, I know you were gutted over these
problems, how is you baby doing?

Cheers

Anne

Thanks for remembering me, Anne. I called my insurance company when my
baby was just born to find out what coverage they provide for lactation
consultants, pumps etc, and it was nil, unfortunately.

I'm not going to take this sitting down, that's for sure. There's a
big government-sponsored breastfeeding campaign going on at the moment
here in the US, and I intend to leverage that as well.

My baby is doing very well indeed on formula. Much as I hate to admit
it, it has saved her little life. I'm looking forward to starting
solids in a few weeks (she's now 4.5 months), when I plan to feed her
only home-made food, to make up for not having been able to breastfeed.

Yes, I was devastated at the time, but I had to accept the situation
for the baby's sake. I cried my eyes out for several days, and then
decided to stop being sad. It's funny what determination can do. I am
okay with it now, but every once in a while when the topic comes up I
well up.

Thanks for remembering me, Anne. I called my insurance company when my
baby was just born to find out what coverage they provide for lactation
consultants, pumps etc, and it was nil, unfortunately.

I'm not going to take this sitting down, that's for sure. There's a
big government-sponsored breastfeeding campaign going on at the moment
here in the US, and I intend to leverage that as well.

that's great, maybe you can find out what insurance companies do, as many
people on here have alluded to it

My baby is doing very well indeed on formula. Much as I hate to admit
it, it has saved her little life. I'm looking forward to starting
solids in a few weeks (she's now 4.5 months), when I plan to feed her
only home-made food, to make up for not having been able to breastfeed.

and that is why formula exists, it's sad that no one gave you proper info
before you had the surgery, but other surgeries such as breast reduction
also carry risks and people still choose them because the misery of backache
caused by large breasts can be far worse than breastfeeding or not.

Yes, I was devastated at the time, but I had to accept the situation
for the baby's sake. I cried my eyes out for several days, and then
decided to stop being sad. It's funny what determination can do. I am
okay with it now, but every once in a while when the topic comes up I
well up.

I'm so glad you just got on with things, I'm not sure I would have in all
honesty. I compromised my first childs health by adamently refusing to
supplement him when we had done absolutely everything else, but he had a
weak suck and my supply was low and I couldn't build it up fast enough, he
needed a kick start, I delayed and delayed and delayed, though eventually he
did have some, but it might have been better if I'd have given in sooner.

Anne

Anne Rogers wrote:

I'm so glad you just got on with things, I'm not sure I would have in all
honesty. I compromised my first childs health by adamently refusing to
supplement him when we had done absolutely everything else, but he had a
weak suck and my supply was low and I couldn't build it up fast enough, he
needed a kick start, I delayed and delayed and delayed, though eventually he
did have some, but it might have been better if I'd have given in sooner.

Anne

We managed to hold off on supplementing only for the first four nights.
She cried so desperately that we had to give in. Initially I didn't
feed her myself, to avoid nipple confusion, so my husband did. In a
way it helped them get closer. In the meantime, I'd keep her on the
breast and she sucked and sucked but nothing came out. About a week
into it, she realised it was hopeless and would turn her head away. It
was torturous for both of us, and it broke my heart, let me tell you.

Anyway, she's a real little Buddha right now, loves her bottle, loves
to eat. She's kept to the 75th-80th percentile by weight the whole
time yet she's only at about the 55th by height. I keep wondering if
she remembers on some level how hungry she was after birth and wants to
eat up now to make up for it.

Anyway, she's a real little Buddha right now, loves her bottle, loves
to eat. She's kept to the 75th-80th percentile by weight the whole
time yet she's only at about the 55th by height. I keep wondering if
she remembers on some level how hungry she was after birth and wants to
eat up now to make up for it.

that's interesting, I've heard a couple of people say similar recently, one
because the milk wasn't get through because not all her ducts and reattached
after a breast reduction and another because the baby had an undiagnosed
cleft palate, so despite trying very hard he just couldn't get the available
milk out. Both have mentioned that their child seems afraid to let a bottle
go as if they can remember that early lack of food!

Anne