When it comes to breastfeeding, there's more money tied up into the act of feeding your baby than many think. From breast pads to breast pumps to bottles to nursing bras, there's a lot to consider. Luckily, the current healthcare plan helps to cover breast pumps for moms, but what about if you have to visit a lactation consultant? Do lactation consultants take insurance, or do you need to come out of pocket for a visit?
Unfortunately, there's no one size fits all answer to this question. According to HealthCare.gov, some insurance plans will cover the cost of a lactation consultant, while others may require pre-authorization from your doctor before paying for the visit. It truly depends on your insurance plan. There is a loophole, though. The American Academy of Pediatrics (AAP) noted that a visit with a lactation consultant can be considered a preventative service, meaning under the Affordable Care Act, you can have up to six low-cost or free sessions with a qualified lactation consultant.
The trick with any type of insurance coverage is knowing if the healthcare provider you're seeing is in your network or not. For some insurance plans, you might need to see a lactation consultant that works in your pediatrician's office or in a hospital. For others, you may be able to see a private practice lactation consultant without an issue. It depends on the type of plan, coverage, and benefits you currently have or will eventually be made avialable to you.
There's also another issue — licensure. According to the United States Lactation Consultant Association, only two out of the 50 states have secured licenses for International Board Certified Lactation Consultants (IBCLCs) and those states are Rhode Island and Georgia. Which means 48 other states don't recognize any lactation consultants as solely licensed for providing lactation support.
IBCLC Rachel O'Brien noted on her website that this is a problem — the Affordable Care Act may ensure that insurances cover visits with a lactation consultant, but an insurance company may deny coverage if a professional isn't licensed. Because anyone can call themselves a "lactation consultant" without proper licensing, insurance companies are wary of paying claims.
So what can you do? O'Brien noted that in her private practice, she gives her client a bill to mail to their insurance company for reimbursement of the visit. If your insurance company doesn't pay it, you have the option to appeal.
If all of that is too confusing, call your insurance provider. They can give you more details on the benefits and coverage of your plan, and they can also direct you to a hospital or doctor's office that has an IBCLC on staff if they aren't willing to cover those in private practice. It's also worth noting that lactation consultants want you and your baby to have a successful breastfeeding relationship. If you think you won't get your visit covered by insurance, call the IBCLC. They may be able to work out a payment plan with you. What matters most is a healthy mom and baby, so consider a visit with your lactation consultant a priority if breastfeeding isn't going well.
