Can I get insurance coverage for an IBCLC lactation consultant?
Yes– the visit should be, but insurance companies are slow to get the ball rolling! Technically speaking, new families with health insurance are entitled to SIX visits of breastfeeding help. While that sounds wonderful, the reality is not so easy.
Many insurance companies cover 100% of your visit if the Lactation Consultant is an ‘in-network’ provider. The problem is, most private practice LCs are not ‘in-network.’ If this is the case with your insurance company and you’re not aware of any LCs in their network, ask your insurance company about their ‘exception gap’ policy.
Regardless of whether or not you have a reimbursement policy, Long Island Breastfeeding professionals can provide you with a superbill to submit to your insurance company. Many families have also found their flexible spending accounts helpful for this purpose.
Most families find they have some sort of coverage/reimbursement even if they didn’t initially think so. We understand that the process can be a bit confusing and overwhelming but we hope to make the process as easy as possible for you.
WHAT YOU CAN DO NOW:
Here’s our suggestion: Call your insurance company and ask them what you are entitled to. Explain to the insurance company that you are aware that you’re entitled to lactation services under the ACA (Affordable Care Act) and that you’d like to know how much you will be reimbursed for. Asking for a ‘pre-approval’ code may be helpful as well…this way we’ll have everything we need to provide to them!
It’s important to keep track of who you’re speaking with and when, as insurance companies are notorious for miscommunication. If one person doesn’t have the answer for you- ask to speak to someone else!
The following link may be helpful: http://www.nwlc.org/resource/new-benefits-breastfeeding-moms-facts-and-tools-understand-your-coverage-under-health-care-