UnitedHealth Class Action Says Breastfeeding Support Services Unfairly Denied

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UnitedHealth Group Inc is facing a proposed class action accusing it of failing to cover healthcare services related to breastfeeding, in violation of the Affordable Care Act.

The lawsuit, filed Friday in California federal court by Oakland resident Rachel Condry, claims that UnitedHealth’s plans fail to establish networks that include providers trained to offer services related to breastfeeding, such as lactation consulting.

After the birth of her child in February 2015, Condry sought coverage from UnitedHealth Insurance for Comprehensive Lactation Benefits after her newborn daughter began losing weight due to breastfeeding difficulties.

However, Condry was reportedly denied coverage for an in-home lactation consultant and not issued any reimbursement, resulting in an out-of-pocket expenditure of $556.

According to the Centers for Disease Control and Prevention (CDC), breastfeeding is one of the most effective preventive measures mothers can take to protect their health and that of their children. As such, breastfeeding is an extremely time sensitive event. Initiating breastfeeding within the first hours and days of a newborn’s life can significantly impact its success.

“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 asserts in the 45-page complaint.

In her lawsuit, Condry supports her claims that immediate access to lactation services and products is critical because the window to address such needs is narrow by citing the U.S. Department of Health and Human Services policy regarding breastfeeding services and health plans.

According to the HHS, all non-grandfathered group health plans and health insurance issuers, both in and out of the Affordable Care Act, are required to cover 100 percent of the costs of certain recommended preventative services for women, including “comprehensive lactation support and counseling and costs of renting or purchasing breastfeeding equipment for the duration of breastfeeding.”

Condry’s lawsuit marks the second time in less than six months that the health insurer has been sued over breastfeeding benefits. In October 2016, UnitedHealth was hit with a similar class action lawsuit in Pennsylvania federal court.

This complaint alleges the health care company breached its fiduciary duty by failing to provide in-Network lactation consultants for mothers in the Philadelphia area and other areas nationwide.

Specifically, the lawsuit alleges UnitedHealth fails to provide coverage for breastfeeding support and lactation services and, worse, frustrates the appeal process by failing to properly process or respond to benefit claims and appeals after lactation service benefits are denied.

UnitedHealth’s handling of these insurance claims resembles a “Kafkaesque bureaucratic nightmare” in which written appeals “disappear mysteriously” and are never addressed or resolved, according to the proposed class action lawsuit.

Both Condry’s case and the Pennsylvania lawsuit are among the first to use the Employee Retirement Income Security Act (ERISA) to challenge a health insurer’s alleged failure to properly cover lactation services.

Condry is seeking certification for a Class of “all persons, who, on or after August 1, 2012, are or were participants in or beneficiaries of any non-Grandfathered Health Plan and non-federal employee health plan, sold, underwritten or administered by Defendants in their capacity as insurer or administrator, who did not receive full coverage and/or reimbursement for Comprehensive Lactation Benefits.”

The plaintiff is requesting appropriate equitable, declaratory, and injunctive relief.

Condry is represented by Kristen Law Sagafi of Tycko & Zavareei LLP; Nicholas E. Chimicles, Kimberly Donaldson Smith and Stephanie E. Saunders of Chimicles & Tikellis LLP; and Jonathan W. Cuneo, Pamela B. Gilbert, Matthew E. Miller and Katherine Van Dyck of Cuneo Gilbert & LaDuca LLP.

.The UnitedHealth Lactation Benefits Class Action Lawsuit is Condry v. UnitedHealth Group Inc., et al., Case No. 4:17-cv-00183-DMR, in the U.S. District Court for the Northern District of California.