Insurance doesn't cover $3,000 breast milk tab for sick Calgary baby

Baby Amalia was born with a hole in her heart. Beyond her daily medications, there is a natural product that can help boost her weakened immunity and lower her risk of an infection — breast milk.

But her mother can only produce one-tenth of what she needs daily — and it would cost $3,000 a month to purchase enough from a breast milk donor bank, something her teacher parents can't afford.

The milk would be from NorthernStar Mothers Milk Bank, a non-profit charitable organization based in Calgary that supplies donated human milk to sick and premature babies across the country.

The problem: neither Alberta nor any health insurance provider in the country is willing to pay for it, unlike some insurance providers in the U.S. that have started covering the cost of donor breast milk in recent years.

"It's pretty shocking," said Amalia's mother, Charlotte Wallewein, who lives in Calgary.

"The cost is $17 for four ounces of breast milk. So basically you're looking at a Starbucks coffee for every ounce of breast milk."

To access the milk from NorthernStar, Wallewein needs a prescription, which she received from the Foothills Breastfeeding Clinic.

The first-time mother was ecstatic to find a solution after visiting six lactation consultants in the city.

"I've never been able to make more than about three ounces a day," said Wallewein, 35.

"It just hasn't worked."

At four months old, Amalia needs about 30 ounces a day.

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'It's our break-even cost'

"This does seem like a lot of money, but it's our break-even cost," said Jannette Festival, executive director of NorthernStar.

"We have to pasteurize the milk, we have to pay rent, we have to pay employees, we have to train employees. There are certain standards we have to meet by our professional organization," Festival explained.

To keep costs as low as possible, Festival said she only employs part-time staff.

Still, a rigorous testing system has to be in place to monitor for diseases, she said, because the babies who consume the milk are weak to begin with.

Alberta Health Services will cover the cost for babies under intensive care, but once those babies are out of hospital their families are on their own.

Wallewein and her husband, Adam Baranec, are hardly the only ones struggling to pay the bill.

"This happens on a weekly basis," said Festival. "We do have a lot of families who fall through the cracks. Many of them will borrow from family and friends."

NorthernStar offers a charitable program for families with low incomes, but Wallewein and Baranec — both teachers — don't qualify.

Insurance claim denied

Wallewein says she called her insurance provider, Sun Life, to see if it would cover the costs.

"They told me that the milk was considered food even though it's by prescription," said Wallewein.

"But interestingly the insurance company will cover breast milk pumps. So if you're capable of producing that milk and you just need a pump to get it out, that's covered."

NorthernStar supports the call for insurance coverage.

"If you can invest in that baby when it's very small so that it can have an healthier outlook, why wouldn't you do that?" Festiva said. "I mean for an insurance company, it would lower their costs in the long run."

Sun Life Financial issued a statement to CBC News, saying it sympathizes with Wallewein and her family.

"Since this is not an expense that we have commonly been asked about, we are investigating the issue further," the statement read.

Wendy Hope, a vice-president with the Canadian Life and Health Insurance Association, said the issue will be discussed among industry members.

Milk bank offers reprieve

Given Amalia's condition, NorthernStar has agreed to provide milk to Wallewein at a discount for now.

"We just try everything we can to make sure they get the milk," said Festival. "Any ill baby, we have not turned away."

So far, Amalia has experienced one bout of heart failure. According to her doctors, there is a chance the hole in her heart will close on its own.

Wallewein and Baranec have to wait and see if Amalia needs surgery in the future.

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