Does insurance cover lactation consultants? and other breastfeeding insurance FAQs
When you’re having a baby, dealing with health insurance can be one of the worst parts of your journey. Benefits can be murky and hidden at best, and dealing with it while you’re short on time and sleep can make things even worse.
Of course, it’s a good idea to understand your insurance coverage, because pregnancy, birth, and children are expensive. Benefits often cover more than just pregnancy. But one question you might be asking is, does insurance cover lactation consultants? Or, does insurance cover breast pumps? Many new mothers will be surprised to learn that yes, insurance often does.
Breastfeeding is sometimes overlooked when you’re researching healthcare coverage and pregnancy. While you’re pregnant, it can feel more important to focus on insurance coverage for things like doctor’s visits and tests. However, thanks to the rules provided under the Affordable Care Act (ACA), insurance companies are required to pay for lactation services and other lactation support.
To help you understand this confusing topic, we’ve compiled a list of frequently asked questions about insurance and breastfeeding. Although we still recommend that you review the terms of coverage under your specific health plan, these FAQs offer a general explanation about the role of insurance and breastfeeding. Learn what types of lactation counseling are covered by insurance.
Is my insurance plan required to cover breastfeeding support?
Yes. Under the ACA, insurance companies are required to offer a range of services for pregnant women and new mothers. This includes breastfeeding support, supplies, and counseling.
To make breastfeeding more accessible, these services are usually offered without co-pays or deductibles. In some cases, you may have to pay for breastfeeding support, but you will receive insurance reimbursement later. So when women ask, “Does insurance cover lactation consultants?” the answer is usually yes.
What if my lactation consultant is out of network?
Complicating matters a bit is that not all lactation consultants (LCs) are in network with your provider. When a provider is in network, they’ll bill your insurance directly. Easy.
In some cases, in-network LCs may not be in your area at all. When they’re out of network, you’ll have to pay for services up front and submit to your insurance for reimbursement. Ask for a superbill from your provider to assist with that process. This can be where things get tricky. Some mothers and LCs have reported that insurers are improperly denying claims.
How can I appeal a denied insurance claim?
If your insurance company denies your claim, here’s what to do.
First, find out why the claim was denied. Was there an error? Incomplete information? Was the wrong reimbursement code entered? These things can be easily resolved.
Then, find out who needs to initiate the appeal—you or your lactation consultant.
If your insurer tells you that you are required to see a lactation consultant in your network, ask your insurance company to send you the list of lactation consultants in your network. If they do not have someone that could provide services for you—for example, if they don’t do home visits—dispute the claim.
The Breastfeeding Resource has a great sample appeal letter for you to try.
Are breastfeeding supplies and equipment, such as pumps, covered by insurance?
Yes. Most health plans must provide breastfeeding supplies and equipment. These supplies will be made available to new mothers without co-pays, deductibles, or other fees. In some cases, an insurance company will only allow you to rent a breast pump or other equipment rather than purchasing it.
Additionally, breastfeeding supplies and equipment must be covered by insurance “for the duration of breastfeeding.” Although this statute of limitations varies from plan to plan, most new mothers will qualify to receive a free breast pump for up to one year after a child’s birth.
How do I know which pumps will be covered by insurance?
If you’re interested in acquiring a pump and pumping supplies from your health insurance, you’ll probably be wondering what type of pump will be provided. To find out, call your insurance company or visit their website.
Depending on your coverage, you may have multiple options to choose from or very few. The type of pump may also vary across plans. Some plans may cover pumping bags, while others only cover bottles.
How do I get a pump and pumping supplies?
In most cases, it’s easier to order your breast pump and pumping supplies online. Your insurance company will likely have a medical supply vendor they work with who can ship the pump and supplies to your home. Aeroflow is a great resource that does the legwork of interacting with your insurance provider on your behalf.
Another option is purchasing an approved pump and supplies from a retail outlet, then submitting the receipt for reimbursement. However, the reimbursement process can take time and may require additional paperwork.
Does my insurance cover lactation consultants?
Yes. The current healthcare law requires insurance companies to provide new mothers with “comprehensive prenatal and postnatal lactation support [and] counseling.”
In other words, your insurance company will provide you with the services of a lactation consultant without a co-pay or deductibles. Under the law, your insurance company is also required to provide lactation consultant services outside of the hospital.
What breastfeeding support services are covered by Medicaid?
If you’re wondering “Does insurance cover lactation consultants?” and you’re on Medicaid or Medicaid Expansion, the answer is slightly more complex.
Medicaid is affected differently by the ACA than other types of health plans and is not required to cover the same breastfeeding support services. However, most states still provide these services under Medicaid even though they’re not required to.
What if I have an HMO but there are no lactation consultants in my network?
When seeking a lactation consultant covered by insurance, individuals on an HMO plan will be required to use professionals who are in network. However, if there are no lactation consultants in your healthcare network, the insurance company is still required to provide this service. You will be able to see an out-of-network lactation consultant and receive full coverage or reimbursement.
How long will I be covered for breastfeeding equipment and support?
The limitations of breastfeeding support and equipment coverage will vary from plan to plan. Under the ACA, insurance companies are required to provide coverage for the duration of breastfeeding. In some states, this is interpreted to mean one year. Your specific health plan may be different. We recommend calling your insurance company or going online to ask.
Need to find a lactation consultant? We’ve got you covered.
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