I know we discussed this earlier in the year, but do we have anything like this in Australia? Megan.
http://www.sacbee.com/content/news/story/5483588p-6467052c.html A father's quest After his wife's death, he seeks insurance coverage for breast milk By Dorsey Griffith -- Bee Medical Writer Published 2:15 a.m. PST Friday, December 6, 2002 NEVADA CITY -- Wesley Forslund-Mooers is a sturdy 6-month-old with rosy cheeks and lively blue eyes. He scoots. He rolls. He coos. And he offers his toothless smile to anyone who catches his eye. His robust health, says his dad, is due in large measure to breast milk. He believes the milk not only sustains Wesley, but arms him against any number of maladies he may face down the road. But because Wesley's breast milk does not come from his own mother, it is also the source of a brewing battle between Wesley's father and his health insurance company, Blue Cross of California. The battle began shortly after Wesley's mother, Sarah Forslund, died of a massive stroke. Her death came at age 31, just three days after Wesley's birth. The Nevada City couple long had planned to breast-feed their first baby, knowing it decreases risks for many infections and diseases, possibly including diabetes, which runs in the Mooers family. And Tom Mooers was committed to following through, even after his wife's death. "Wes misses so much with the loss of his mother," said Mooers, a soft-spoken 33-year-old with his son's blue eyes and blond hair. "I try to make up for it in every way I can. This is one of those ways." In their serene and rustic home amid tall pines and cedars just outside Nevada City, Mooers teases Wesley with a tickle of the bottle's nipple on his chin. Wesley drinks eagerly, his eyes fixed on his father and his hand grasping his dad's shirt. After Sarah's death, Mooers found a reliable source of safe, donated breast milk at a special bank in San Jose. He asked Wesley's pediatrician to write a prescription for it, and asked Blue Cross to reimburse him for the cost: $3 an ounce, or about $90 a day, for a total so far of $15,138. So far, Blue Cross has refused, leaving Mooers to cover the costs on his own. Blue Cross said no on the grounds that breast milk is a food, not covered except for the treatment of PKU, an inherited defect that causes mental retardation. In a letter listing 31 studies on the health advantages of breast milk, Mooers appealed the decision. Again, he was denied. "They already have determined that Wesley is not ill, and he doesn't have PKU, so we have to stick to what's in the contract," Blue Cross spokeswoman Lisa Mee-Stephenson told The Bee. Mooers filed a complaint with the state Department of Managed Care, which can force health plans to reverse denials of coverage. The state, which will put the issue before a panel of doctors, has not reached a decision on the case. In the meantime, Mooers continues to receive a big red cooler full of breast milk every 10 days. The tiny glass bottles line the shelves of his freezer, individually thawed and warmed for Wesley's feedings. Mooers considers the liquid a precious substance, and not an ounce is wasted. "Getting milk from other people is a far cry from Sarah nursing him," he said. "But it's still an incredible resource, and a lot better than if I had to rely on formula." Sarah and Tom met in 1992 as members of Green Corps, a field school for young environmental activists. Although Tom had a crush on Sarah, they remained just friends in the years that followed, each gaining experience in jobs that promoted their mutual values: land conservation and healthy communities. They became romantically involved during a Green Corps reunion in 1996, then launched a long-distance love affair. Sarah left Vermont in 1998 to join Tom in California, and two years later, they were married in a mountain ceremony. Tom now runs a small environmental group called Sierra Watch; Sarah served as Green Corps' associate director. "We were so close," Mooers said. "It was hard to know where one of us left off and the other started. So much of me was her, and so much of her was me." Sarah loved planning for parenthood. Except for a period of high blood pressure in the month before Wesley's birth, she was healthy throughout the pregnancy, even snowshoeing with her husband last February. The couple had hoped for a natural childbirth. But during a long and difficult labor two weeks after the baby was due, they agreed to a Caesarean section at Sierra Nevada Memorial Hospital. Early the morning of June 13, Sarah delivered a healthy, 9-pound boy. "We were so happy," Mooers said of their brief time as a threesome. "It was the greatest three days. We'd eat dinner every night and give thanks. We spent the time taking care of Wes, holding Wes, watching each other hold Wes." Shortly before Sarah and Wes were to be released from the hospital, Mooers drove home to shower and change clothes, feed their dog and pick up a pint of ice cream for the two to share. When he returned to the hospital, alarms were ringing, lights were flashing and doctors and nurses were rushing in and out of Sarah's room. She had suffered a massive stroke, the result of pre-eclampsia, a rare complication of pregnancy. When it was clear that Sarah would not survive the brain injury, Mooers agreed to allow donation of her healthy organs. It was something the two had discussed and that Mooers understood; his father is alive today because of the donated kidney and pancreas he received 11 years ago. Sarah's heart, liver, kidneys, pancreas and corneas all were transplanted. In the days and weeks that followed, the couple's small home filled with family who came to support Mooers and his newborn baby. Sarah's older sister, who a month earlier had given birth, came from Massachusetts and nursed Wesley. But Mooers needed a long-term solution. So he turned to a milk bank in San Jose. Mother's Milk Bank is the only such facility in California, and one of just a handful in the United States. In the mid-1970s, before the explosion of AIDS and concerns that the disease could be spread through donated blood and tissue, nearly a dozen milk banks operated in California alone. Today, breast milk banks follow stringent screening and processing requirements, and are regulated by the state along with blood and tissue banks. Donors are interviewed and tested for illnesses, and their milk is screened for antibodies to HIV, hepatitis C, syphilis and other infections. Donor milk is dispensed only by prescription and after it has been heat-treated and tested to be bacteria-free. Unlike donor blood, which has to match the recipient's blood type, donated breast milk can be used to feed any child. Most of the Mothers' Milk Bank clients are premature infants whose mothers cannot provide breast milk, said Pauline Sakamoto, the bank's executive director. Infants who have digestion problems, formula allergies, immune system deficiencies or major surgeries also are recipients. Occasionally, Sakamoto said, the bank provides breast milk to a healthy baby whose mother has died, as in Wesley's case. All told, the bank provided about 140,000 ounces of milk last year. But there is no consistency when it comes to insurance coverage of breast milk. Medi-Cal, the state's insurance program for low-income children, covers breast milk, with no limitations, as long as the doctor prescribes it, said Stan Rosenstein, who oversees Medi-Cal for the state Department of Health Services. Medi-Cal, during the six months from July 2001 to December 2001, spent $29,045 on breast milk, the last period for which figures were available. "We are strong supporters of breast feeding, and there are unfortunately people who get into a situation where they need the services of a milk bank," he said. Most private insurers, however, only cover banked breast milk for hospitalized premature infants, said Dr. Ronald Cohen, a neonatologist in San Jose and the milk bank's volunteer medical director. While the advantages of breast milk over formula are indisputable, he said, getting an insurance company to cover it for an otherwise healthy baby is another matter. "We are asking the insurance company to pay for a wet nurse for a normal child," he said. "We all know plenty of people brought up on formula who have lived and for whom life is good. A full-term, healthy kid will get regular formula and do fine." But Mooers is in no hurry to switch to formula. On unpaid leave from his job, he is living off modest savings and plans to sell his wife's car so that, whatever the outcome of the dispute, cash-flow problems do not dictate whether Wesley continues to get breast milk. And he refuses to back down in his fight with Blue Cross, which he pays $160 a month to cover Wesley's medical needs. "I pay for his health insurance so he can get the prescription for this substance," he said. "It's so much more than food. There is so much in breast milk that you can't get at a grocery store." ------------------------------------------------------------------------ About the Writer --------------------------- The Bee's Dorsey Griffith can be reached at (916) 321-1089 or [EMAIL PROTECTED] ------------------------------------------------------------------------ -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
