Insurance & Lactation Coverage
Understanding how to get healthcare and insurance coverage within the USA is a nightmare. Especially for lactation services!
So many questions that no one seems to know the answer to — Is this provider in network? What will I have to pay for this procedure? Why didn’t I get coverage for this appointment? You can hardly get a human on the phone to even try answering your questions AND their answer is always couched in the phrase “this is not a guarantee of payment”.
Blah Blah Blah!
When it comes to understanding lactation coverage, it can be even more challenging despite the ACA mandating coverage.
Some Background
When the Affordable Care Act (ACA) passed in 2010 and was signed into law it changed the lactation landscape in 2 ways:
It mandated that working parents need reasonable break time and a private space to express human milk for up to 1 year after birth (see this post for more info and updated protections)
It required health insurances to cover the costs associated with breastfeeding and lactation
While this sounds great in theory, it can be challenging to navigate because insurances set their own rules for coverage.
Get the most out of your insurance coverage
Breast Pump: Call your insurance provider and ask…..
What kind of pump do you cover?
Where can I get a pump?
How much out of pocket will I pay for a pump?
Do you cover rented pumps?
Do I need prior authorization, a referral or a prescription for a pump?
If I don’t like any of the pump options, can I pay the difference between the covered and non-covered pump?
Lactation Consultations: Call your insurance and ask…..
Do you have a list of in-network LACTATION providers? Not just Pediatricians, OBGYNs or Lactation Consultants only available in the hospital
If there are no in-network providers, how do I get coverage for an out-of-network provider?
Do I need prior authorization for a visit?
If you decide to see an out-of-network provider and want reimbursement from your insurance, you’ll need an invoice or receipt with:
Diagnosis Code (ICD-10)
Procedure Code (CPT COde)
Date of Service
Amount Paid
IBCLC’s EIN (Employer ID/Tax ID)
IBCLC’s NPI (National Provider Identifier)
IBCLC’s contact info and signature
You may need to submit separately for parent’s insurance or baby’s insurance depending on your plan.
This isn’t the end of the road
If you receive a denial for your request of reimbursement, ask why! You can fix errors and resubmit, appeal the decision or even complain to your state’s insurance board. You already pay enough for health insurance, get the most out of it!
The Lactation Network
The reason for many of the problems in finding lactation coverage is the lack of in-network providers. Insurance companies are hesitant to contract with IBCLCs or just don’t know how.
I use The Lactation Network to expand the range of insurances that I am able to accept. They process the claims for me and guarantee coverage for 6 visits without an out of pocket cost for you (if they work with your insurance).
You can check your insurance coverage for a visit with me HERE. Once you submit your information, both you and I will receive an email if you are covered or not.
They even cover individual pre-natal consults! If you have specific concerns and feel too nervous about a group class setting, this is a perfect option for you.
I’m covered through The Lactation Network, now what?
Schedule your in-home or virtual visit with me HERE. I greatly look forward to working with you and helping you meet your goals, whatever they are!
Unfortunately, I’m not covered through The Lactation Network. Can I still see you?
Yes! I am able to provide a receipt for out-of-network reimbursement. If you have trouble getting reimbursed, please reach out at any time. I am here for you! I want you to get the coverage you deserve. Schedule your in-home or virtual visit with me.
