CareFirst Agrees to $3.6 Million Settlement of Breastfeeding Benefits Claims

On December 10, 2018, CareFirst Inc. (“CareFirst”) agreed to a $3.6 million uncapped settlement regarding claims that it violated the Affordable Care Act (“ACA”) in failing to cover comprehensive breastfeeding and lactation counseling and support.

Proposed class members will receive complete reimbursement for any cost-sharing CareFirst imposed on them, and CareFirst will also cover the costs of administering the settlement. The motion for preliminary approval highlighted that “there is no limit on the total dollar amount of the cash settlement payments that CareFirst may make to class members for authorized claims.”

Named Plaintiffs, Lindsay Ferrer, Amy Haddad, and Sarah Sorscher, brought the suit in October 2016, alleging that CareFirst failed to include trained breastfeeding support and counseling providers in-network, forcing women to pay for their services out-of-pocket. The insurance company would then only partially reimburse or completely deny women’s out-of-network claims, in violation of the ACA.

The proposed class is comprised of nonexempt CareFirst plan participants or beneficiaries who were denied complete coverage or reimbursement for lactation claims between August 2012 and August 2018. Class members will be reimbursed for the out-of-pocket amounts they paid as co-payments or co-insurance, and those that were applied to their deductibles.

The settlement estimates an automatic $400,000 payout for over 10,000 claims, and a payout of more than $3.2 million following affirmation from proposed class members for 90,0000 claims.

In addition to monetary relief, the settlement calls for CareFirst to add trained providers of breastfeeding and lactation counseling and support to its network, and to provide plan members with information about the services.

The legal team at Shepherd, Finkelman, Miller & Shah, LLP (“SFMS”) has significant experience litigating class action and benefits matters.  If you have any questions regarding this subject or this posting, please contact Nick Lussier or Chiharu Sekino.  We can also be reached toll-free at (866) 540-5505.

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