New Moms Face Snags with Tricare Breastfeeding Changes

New parents connected to the military have relied on Tricare’s breastfeeding support programs for years. Moms have received breast pumps and supplies for free. Now, parents of some infants may also qualify for donor breast milk, too!

Expanding safe feeding options that allow parents a variety of solutions that fit the business of military life is always a good thing. But all this good also comes with a few hiccups.

New Moms Face Snags with Tricare Breastfeeding Changes

While donor milk coverage has been added, the notoriously generous breast pump program has been slapped with new restrictions.

$16 Million Breast Pump Overspend Leads to Major Changes

During a 2018 Inspector General audit, over $16 million in overspending on breast pumps and associated supplies was discovered. In one case, a breast pump that normally cost $200 at major retailers was billed at $1400 to Tricare.

These inflated bills were caused by beneficiaries purchasing a pump directly from a medical supply company, which would then bill Tricare. Another option was to purchase a pump from other retailers on their own, submitting their receipt for reimbursement later.

Now, Tricare is instituting a reimbursement cap and streamlining the process for filing a claim.

Here’s what you need to know now:

• Tricare will reimburse qualified beneficiaries up to $312.84 (CONUS) or $500.55 (OCONUS) during 2019
• There are no restrictions on where beneficiaries may purchase their pump
• Deluxe models are no longer allowed; contact your Tricare call center for specifics
• To get reimbursed for a pump, you must have or obtain a prescription from your PCM or another in-network provider
• Initiate your claim for DD-2642; attach your prescription and a copy of your receipt when submitting the claim
• There are limits on milk collections containers, replacement parts and other associated supplies
• You are limited to one pump per birth event

For questions regarding the specifics of your coverage, please contact your Tricare regional office. You can call Tricare East at 1-800-444-5445 or Tricare West at 1-844-866-9378. Members stationed OCONUS should also call their regional call center.

Canceled Orders, Big Debts

With the major changes to how Tricare handles breast pumps, many beneficiaries have been left up in the air.

As of July, over 5,000 claims were pending at Pumping Essentials. The CA-based company also canceled all current and future orders of pumps and supplies for Tricare beneficiaries.

Pumping Essentials has also officially cut ties, for the time being, with the Pentagon due to outstanding debts owed on already ordered pumps and supplies. In July, the DoD owed Pumping Essentials over $1 million for past orders and claims. Pumping Essentials, in a prepared statement, claims that contractors like Humana and HealthNet were negligent in paying bills on time.

“[The contractors] have drastically mismanaged the handling of these claims, resulting in significant amounts of unpaid claims to Pumping Essentials and many other providers. … At this time, the volume of unpaid claims has put our company in a position where we can no longer sustain the debt that is accruing,” wrote Pumping Essentials officials.

New Benefit, Zero Instructions

Parents of infants with certain medical concerns can now access milk banks with limited or zero cost. But the implementation of this new benefit has been anything but smooth.

Donated milk is used to help totally feed or provide a supplemental food source for infants who meet one or more medically complicating conditions:

• very low birth weight, often due to extreme premature birth
• disorder or surgery that impacts the GI tract
• failure-to-thrive diagnosis
• unable to drink formula, causing weight loss or failure to thrive
• low blood sugar
• heart disease
• organ transplant
• when maternal milk isn’t available and the infant has a serious health concern
• other serious health conditions, at the discretion of the PCM or specialists

Milk banks are located around the country and world, but the extremely high cost has limited or prevented access for many. Donated milk can cost as much as $5 per ounce, with daily bills costing upwards of $150 during peak consumption periods.

Military families have gone deeply into debt trying to care for their new baby. With Tricare’s new policy, retroactive to January 2019, military families will bear less of a financial burden in an already stressful situation.

However, Tricare and the Defense Health Agency announced this new policy without creating or communicating a complete plan of action to providers and associated agencies.

There are questions about what is covered and who is responsible for different elements of using donor milk.

Lactation specialist Pauline Sakamoto said that Mothers’ Milk Bank in San Jose, CA was overwhelmed with calls after the new policy was introduced.

“There continue to be questions as to what the benefit is and what the families are responsible for paying,” Sakamoto said. “For example, shipping costs. Is that part of Tricare coverage or not? And to some extent, Tricare has a co-pay, but we aren’t seeing that families are getting requests. There are a lot of issues right now swarming around this coverage.”

Getting Your Baby Banked Milk

Right now, parents who are interested in exploring how donor milk may benefit their baby should speak to their PCM or medical care team. A prescription is required.

Your child’s doctor should be actively monitoring your baby’s case and writing a new prescription every 30 days. Babies may consume donated breast milk, covered with a prescription, until 12 months of age as long as it is deemed medically necessary.

Parents may need to pay for the donor milk upfront, submitting a claim to Tricare for reimbursement after the fact. With all claims, parents should submit an active prescription and their bill from the milk bank.

In case of confusion, call your Tricare regional call center stateside or overseas. Customer service representatives should be able to help you navigate the billing and reimbursement loopholes.

Have you used either the new breast pump or donor milk benefit? We’d love to hear about your experiences!