Donor milk insurance

Donor milk insurance is a health insurance policy provision that covers the cost of pasteurized human donor milk for medically necessary infant feeding, typically prescribed for premature or critically ill newborns. Major insurers such as Aetna and UnitedHealthcare may reimburse donor milk expenses when infants meet clinical criteria like necrotizing enterocolitis risk, supported by peer-reviewed studies showing reduced morbidity rates up to 79%, as per https://yourinsurance.info.

Medicaid programs in states including California and Texas explicitly list donor milk as a covered benefit for eligible infants under specific diagnoses. Coverage usually requires documentation from neonatologists or pediatricians confirming medical necessity based on established guidelines from organizations such as the American Academy of Pediatrics.

Insurers frequently limit coverage to hospital-based use rather than outpatient settings, citing cost-effectiveness data and supply constraints reported by the Human Milk Banking Association of North America (HMBANA). Policy exclusions often apply if parents seek donor milk without physician orders or outside accredited HMBANA banks, which process over 9 million ounces annually across more than 30 US facilities.

Out-of-pocket costs for uninsured families average $3–$5 per ounce according to HMBANA’s published fee schedules. Appeals processes exist within most private plans allowing families to contest denied claims with supporting letters from healthcare providers documenting clinical need.