UnitedHealth Sued to Cover Breastfeeding

OAKLAND, Calif. (CN) — In a federal class action, a California woman accused UnitedHealth Group of denying new mothers coverage for breastfeeding services, in violation of the Affordable Care Act, ERISA and 25 years of national health policy.

Lead plaintiff claims UnitedHealth and three subsidiaries refused to reimburse her for a $225 in-home lactation consultation after her newborn daughter began losing weight due to difficulties breastfeeding.

After UnitedHealth denied her claim as “not a reimbursable service,” Condry says she chose not to submit claims for two additional consultations that cost $181 and $150.

Condry says the Affordable Care Act requires coverage of women’s preventive services, including breastfeeding support, supplies and counseling. Denying it “improperly shifts the cost of coverage of a preventive service onto women, [and] is directly counter to the ACA provisions on preventive services and ERISA duties,” Condry’s attorney Kimberly Donaldson Smith said in an email Tuesday.

The federal government has promoted breastfeeding for a quarter of century. A string of surgeons general have recommended breastfeeding for improving public health. The American Academy of Pediatrics advises new mothers to breastfed exclusively for the first six months of a child’s life, with continued breastfeeding interspersed with solid foods for at least the first year, according to reports cited in the complaint.

The Centers for Disease Control and Prevention touts breastfeeding as one of the most effective ways mothers can safeguard their children’s health.

Among the way UnitedHealth dodges the ACA is by failing to establish networks of trained breastfeeding consultants, Condry says, so mothers either get no breastfeeding benefits because they can’t afford out-of-network rates for them, or they do get them, but pay all or most of the fees.

“Some insurance companies have fallen woefully short in the delivery and coverage of such services and are erecting administrative barriers that deter mothers from getting the services to which they are entitled,” Donaldson Smith said. “As a result, mothers and their infants have suffered, and the impact is not only in the pocketbooks of the mothers, but in the future health of their children.”

A UnitedHealthcare spokeswoman declined to comment Tuesday.

The U.S. Department of Health and Human Services says in its website that all qualified health plans, inside and outside the ACA marketplace, must cover breastfeeding counseling, support and supplies for pregnant and nursing women, even if they were pregnant before their coverage began.

“It’s just one of many benefits of the health care law that let women and their doctors, not insurance companies, make decisions about a woman’s care,” wrote then-HHS Secretary Kathleen Sebelius said in a 2012 statement.

In 2011, HHS issued women’s preventive services guidelines in which it estimated that breastfeeding can save $1,200 to $1,500 on infant formula in the first year of a baby’s life. If 90 percent of U.S. families followed federal recommendations to breastfeed exclusively for six months, the HHS estimated the country would save $13 billion annually in reduced medical costs and costs associated with premature death.

“Therefore, access to and coverage for comprehensive lactation benefits advances the long held public policy goal to improve the health of Americans by increasing access and diminishing the cost barriers to sustained breastfeeding during the first year of a child’s life,” Condry says in the 45-page complaint.

She seeks class certification, declaratory judgment, an accounting, reimbursement, disgorgement of unjust profits, damages for unjust enrichment, ACA violations, discrimination, equitable relief, and costs of suit.

Donaldson Smith is with Chimicles & Tikellis of Haverford, Pa.; she is assisted by Kristen Law Sagafi with Tycko & Zavareei  in Oakland.

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