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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. |
#2
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Breastfeeding not medically necessary
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. |
#3
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Breastfeeding not medically necessary
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 |
#4
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Breastfeeding not medically necessary
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 |
#5
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Breastfeeding not medically necessary
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 |
#6
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Breastfeeding not medically necessary
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. |
#7
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Breastfeeding not medically necessary
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. |
#8
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Breastfeeding not medically necessary
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 |
#9
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Breastfeeding not medically necessary
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. |
#10
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Breastfeeding not medically necessary
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 |
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