Dr. Anne Eglash says the evidence is overwhelming and incontrovertible: "There clearly is a better outcome for babies [who receive] donor breast milk than formula." It promotes intestinal development and reduces the risk of a particular life-threatening disease. And donor milk costs about the same as some specialty formulas.
For these reasons, Eglash, a family practice physician with UW Health, is upset that a local HMO refused to cover the cost of providing it to a prematurely born baby. "A health plan should pay for donor milk," she argues.
Some background. Donor milk comes from women who have, well, milk to spare. Their babies may have died or they are pumping more than they can use and don't want their milk to go to waste.
In 2006, Eglash and others started the Mother's Milk Association of Wisconsin, which operates out of Madison. Because Wisconsin has no milk bank - something the group is working to change - the state's donor moms are screened and tested by a milk bank in Ohio. Their milk is stored in freezers in several locations, including Eglash's UW Health Clinic in Mount Horeb and the Madison Birthing Center, and flown by the volunteer nonprofit Angel Flight to Ohio once every few weeks.
Ohio, in turn, makes this milk available for use by those in need - the infants of moms who for some reason are unable to provide their own breast milk.
Recently, a baby born prematurely at St. Mary's Hospital was provided with donor breast milk from Ohio, including some donated in gratitude for the contributions from Wisconsin women. A public health nurse who is a family relative says it was the first time St. Mary's Natal Intensive Care Unit allowed the use of donor milk.
The approximately $400 cost for the milk beyond what was donated was added to the family's bill and submitted to its HMO, Dean Health Plan. Dean refused to pay for it, saying, in the stilted prose of health-care bureaucrats, "A Dean Health Care Plan Medical Director has reviewed this request and determined that donor breast milk is not medically necessary as over the counter infant formula is available."
Eglash intends to help the family contest this denial at a review set for June 17. "I think we have an excellent case," she says. "That baby has every right to have ideal nutrition."