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  • Writer's pictureJennifer Kowal

Is My Lactation Care Covered by Insurance?

Updated: Jul 5

Lactation care is health care and should be covered but we all know that not everything that should be covered always is covered. The Affordable Care Act required that insurance companies cover lactation care but those insurance companies have multiple ways of getting around that requirement. I will outline those work arounds so you are aware of what your insurance policy may be doing and how you can respond to hopefully get your needs met.

Insurance companies are businesses and we all know that businesses exist to make money. The way an insurance company makes money is by spending less than it makes. it does that by paying out less for services than it brings in in premiums. But how do they not pay if they are required to do so?

  • By not having private practice IBCLCs in network. They tell families they will only cover in network IBCLCs but then they do not credential IBCLCs unless they also hold high level medical credentials like MD, DO, NP, PA, RN, etc. This is a barrier to care because the number of high level medical providers who get their IBCLC credential is low and those that do, spend the bulk of their time performing the duties related to their higher medical credential and are not putting their time and focus in the continuing education to competently and properly support lactating families. Also, believe it or not, those with higher medical credentials DO NOT HAVE to prove supervised clinical hours and competency of knowledge or skills to meet the requirements to sit the board exam. This means that most of the higher level medical providers who hold the IBCLC credential may not be as qualified as an IBCLC in private practice who ONLY sees lactating and/or bottle feeding families to help with latch, milk production, infant growth, complex feeding concerns, and more. Are there exceptions? Yes of course. But when you look at your insurance policy and only see one IBCLC in network who is 2 hours away from you, its likely because your insurance wont accept non medical IBCLCs in network.

  • By not paying the IBCLC for the work they are doing for two patients. When we see a family we have 2 patients, the parent and the baby. We take history on both, evaluate both, assess both, create a care plan for both. Both are in our care for similar but different reasons. We bill insurance for both. But when insurance will not reimburse for both in a way that fairly compensates the provider for their time with TWO patients, then providers are forced out of network. One way lactation providers try to get around this is by offering very short visits so they are paid for thier time adequately. This would explain why you may have seen someone but it didn't seem like they were able to spend enough time with you to answer all your concerns.

  • Insurance companies will not reimburse parents in full for their out of pocket expense to see a private practice IBCLC not in network. When insurance will not reimburse in full, parents may find it extremely difficult to financially cover the cost of lactation care. Insurance companies put large portions to patient responisbility due to deductible, co pay, co insurance, etc. All of this is simply an aim to keep their money for themselves. One particular company tells families they are covered in full when the subscriber reaches out to verify benefits ahead of time and then once that person has paid out of pocket and utilized the services and submits the superbill to their insurance, the company denies...and denies...and denies reimbursement. Families are then forced to give up getting reimbursement or threaten to report the insurance company to the Insurance Comminsioner of their state.

When you are fortunate to find a private practice lactation provider in network, that person is usually a micro business with very few administrative or billing employees and little availability to intercede on behalf of appropriate reimbursement so they have to limit the duration of their services. When you find a provider who is out of network, you have to foot the bill up front and advocate for yourself to get reimbursement, while recovering from birth, caring for a baby, etc.

So what do families do?

  • The most common response is to not get the help they deserve. This is egregious because lactationg people deserve to have the help they need caring for their body and their milk supply. And babies deserve the care as well. This shouldn't even be an option.

  • Families pay out of pocket for ongoing care that can be expensive and make it difficult to cover other adjacent care that may be necessary for baby, like manual osteopathy, frenotomy, chiropractic, etc.

  • The Lactation Network aims to change that for families. The Lactation Network is a Durable Medical Equipment supplier who aims to support lactating and infant feeding families by interceding for families and IBCLCs. TLN is in network with many insurance companies and can bill for services directly to those companies. They contract with IBCLCs who agree to a set fee for the lactation services. The family allows TLN to verify their benefits here and then when they are verified, can see a provider at little or no cost. The IBCLC submits documentation to TLN showing the visit happened and TLN then submits claims to the insurance company and does all the work! The families get the lactation care they need and the IBCLC can spend their time in direct patient care instead of fighting a broken health care system.

Birth and Postpartum is NOT the time for families to be fighting a broken health care system. Submit your insurance info here to see if you qualify for services at little to no cost to you. We very much want to help in person and virtually!


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