Breastfeeding and Insurance

The Affordable Care Act has made great strides in how insurance companies pay for lactation services. The Affordable Care Act states, “Health insurance plans must provide breastfeeding support, counseling, and equipment for the duration of breastfeeding. These services may be provided before and after birth.” The only exceptions to this are state funded health care plans and grandfathered plans. Here in Texas, where IBCLCs (International Board Certified Lactation Consultants) are not yet licensed and are scarce, insurance companies sometimes illegally deny coverage of services.

Some insurance companies are wonderful. They follow the law exactly and parents are able to have IBCLC services covered at no cost or trouble. Other insurance companies routinely deny coverage. This does mean all is lost, but it does unfortunately mean that it will require further conversations with your insurance provider. Thankfully in October 2015, the United States Department of Labor clarified some ambiguity in the Affordable Care Act stating that all insurance companies must provide parents with a list of in-network lactation counselors. If this isn’t possible (and more than likely it will not be), they must cover an out-of-network provider.

When contacting your insurance provider to check coverage, The National Women’s Law Center has a great script to follow (available on page 8 of this document). Should you have any trouble, please contact the National Women’s Law Center according to the script. As a new or expecting parent, battling with your insurance company is the last thing you have time to do. However, taking the time to do this will help reinforce to insurance companies that these are important services for new parents, and it will also lay the groundwork for other families to receive the breastfeeding support they will need. We are willing to help in any way we can and continue to fight for insurance coverage in Texas!

The lactation consultants at Special Addition are currently in-network providers for the Seton Employee plan and are working towards similar agreements with other insurance groups. If you are not enrolled in the Seton Employee plan you will pay for your consultation at the time of service, and your IBCLC will provide you with a superbill containing all of the codes and information your insurance provider should require in order for you to seek reimbursement.

If for some reason your insurance company does not cover the cost of the services you receive here at Special Addition, we want to assure you that in paying cash, you will be receiving the absolute best breastfeeding support in our area. We are highly recommended by many pediatricians, nurses, fellow mothers, and local birth professionals for a reason: we care deeply about supporting mothers and babies, and about helping them meet their breastfeeding goals.

-Used with permission from Leah Segura, modified by Kristen Rosin