Beginning January 1, 2025, AB3059 recognizes medically necessary donor milk as an essential health benefit for commercial health plans in California. Donor milk is also billable under Medi‑Cal using CPT code T2101.

Please keep in mind: Insurance coverage typically applies only when donor milk is medically necessary for the infant. Plans generally do not cover donor milk as a nutritional or elective supplement.

First Steps:

1. Ask your healthcare provider if donor milk is medically necessary for your baby
2. Call your insurance to determine if donor milk is a covered benefit
3. Review UCHMB's insurance list to see if your plan is in-network or out-of-network

Medical need varies from infant to infant. Insurance may cover donor milk when a condition affects feeding, growth, or digestion. Examples include, but are not limited to:

• Very low birth weight (under 1500g) or prematurity (under 32 weeks)
• Gastrointestinal anomalies, metabolic/digestive disorders, or recovery from intestinal surgery
• Severe formula intolerance with feeding difficulties, weight loss, or medical contraindications
• Congenital heart disease, pre‑ or post‑organ transplant
• Any other serious condition where donor milk support treatment or recovery

Your healthcare provider can help determine whether donor milk is medically necessary for your baby.

Important Notes About Maternal Need:

Insurance policies vary, and a small number of plans may approve donor milk for maternal reasons (such as low milk supply or breastfeeding challenges). However:

• Maternal need is placed in a lower priority tier under UC Milk Bank’s Prioritization Guidelines.
• Because our priority is medically fragile infants, we may not be able to dispense donor milk for maternal need, even with insurance authorization.
• Availability is determined by medical priority and inventory at the time of the request.

If your plan is out‑of‑network, we are NOT able to bill your insurer directly or submit claims on your behalf. Many families are still able to pursue reimbursement independently.

Our Reimbursement‑Support Model includes:

• Families purchase donor milk directly
• Families may seek reimbursement from their insurance
  provider
• We provide helpful documentation that insurance
  companies commonly request

Documentation We Can Provide:

• Itemized invoices and payment receipts
• Product and processing descriptions
• Billing or reference codes (when available)

Because coverage varies widely, we encourage you to contact your insurance provider to ask about potential reimbursement and required documentation.

This is a list of Insurance Providers that UC Milk Bank has worked with:

- Central California Alliance for Health

- IEHP

- Alameda Alliance for Health

- Partnership Health Plan

- Rady Children's Health Network

- Kern

The process for Insurance Coverage includes:

1. Submit to UC Milk Bank a Provider Letter requesting an Exception for Medical Need

2. Once approved, Provider to submit referral to Insurance for Authorization. Copy of Authorization sent to UC Milk Bank

3. Once Authorization is received, Milk Bank to create a Letter of Agreement (LOA) with Insurance

Because donor milk availability can vary, all orders for any condition, diagnosis, or insurance type are always subject to inventory and prioritization guidelines. This means that even with insurance authorization, dispensation is not guaranteed if supply is limited.

Insurance coverage or reimbursement is not guaranteed. All decisions are made solely by the insurance provider. Dispensation of donor milk is always subject to inventory and UC Milk Bank Prioritization Guidelines.