Donor breast milk not always covered by health insurance

Getting breast milk from donors can be a medical necessity, but health insurance doesn't always cover it.

- Carla Doherty gave birth to a premature baby girl, Marlo, who weighed 1 pound 5 ounces. Carla says she had a 60 percent chance of surviving and an 80 percent chance of having a disorder. Right away doctors told Carla she needed to give her baby breast milk.

She was able to produce her own milk and a lot of it. But at three weeks, Marlo developed an infection: necrotizing enterocolitis, a devastating disease that affects mostly the intestine of premature infants. Doctors had to intervene. They cut out a centimeter and a half of her intestine and created an ileostomy.

This setback made getting Marlo breast milk even more imperative because babies with necrotizing enterocolitis have a better chance of surviving if they feed on breast milk, Carla says.

But about a month ago, Carla noticed a difference in the amount of milk she was producing. It was not enough to keep feeding her now 5-month-old girl. Marlo drinks 28 ounces a day. She immediately turned to the New York Milk Bank for help.

In order to get donor milk from the milk bank you must a have a prescription from a doctor, which she has. However she faces a bigger problem. Carla's private insurance, Emblem Health, won't cover the cost. Neither will Marlo's Medicaid. 

A 100 milliliter bottle of donor milk at New York Milk Bank costs $15. Carla says she would have to pay about $250 a day now. But as Marlo gets older that amount could increase to $500 a day. Say says she doesn't have that kind of money.

A bill that was proposed by the New York Senate would make Medicaid cover the cost of donor breast milk that is medically necessary for certain preemies, like Marlo. The bill has passed both the Senate and Assembly. However, that bill would need to be signed by Gov. Andrew Cuomo in order to become law.

The governor's office said in a statement: "This is an important issue that we don't take lightly. The specifics of the legislation, which hasn't been sent to us as of yet, remain under review by our counsel's office."

However after reaching out to Emblem Health late last week, things changed for baby Marlo. Carla received a letter from Emblem Health that read in part: "Emblem Health has approved the request for donor breast milk. A single case agreement is being worked on with New York Milk Bank."

In a statement to Fox 5 News, a spokesperson for the insurance company said: " Emblem Health's top priority is providing members and their families access to high quality care. We are aware of this issue and have been actively working to resolve it."

Even though Carla won the battle and will have donor milk to give her daughter, she will continue fighting for every other premature baby who medically needs breast milk.

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