Breastfeeding support, supplies and counseling are part of women’s preventative services. They are covered by your health care plan for as long as you are breastfeeding. You can enjoy these services with no co-payments, deductibles or co-insurance.
There’s some confusion about what the Affordable Care Act allows. I’ll clarify five common confusions and list resources to help you.
• Insurers can require that you see someone in their network. However, if they can not provide someone ‘in network’, they still have to cover someone who is ‘out of network’. You can call one on your own.
• Home visits with a lactation consultant are covered. The law states that lactation support is not restricted to only in hospital visits.
• “For as long as you are breastfeeding” means there is no limit on when you can have a visit with a Lactation Consultant.
• There is no limit on how many visits you can have. Two or three or more, they are all part of the preventative services.
• An IBCLC is an internationally recognized certification, not a licensure. No state in the US has a license for IBCLC. However, the World Health Organization and the U.S. Surgeon General recognize this credential. It is the most rigorous qualification for lactation education.
A health plan that began before March 23, 2013 may be grandfathered, that is, they don’t have to comply with the law until they make major changes. Call the number on your insurance card, or your H.R department, to confirm that.
We suggest you schedule a visit as soon as you need it. Pay the IBCLC directly, send the invoice (make a copy) to your insurance company and you should get reimbursed.
If that claim is denied, you can appeal it. It’s helpful to keep records of all correspondences with your insurance company. (Write down when, with whom and what was said.) The following are resources to help you get what you need and deserve.
• The National Women’s Law Center has a hotline for you. You will get a reply within 48 hours.
1 866 745 5487
• You can download their very practical ‘tool kit’. It explains the benefits for breastfeeding mothers under the new health care law and provides step by step guidance for talking with insurance companies.
• LCHomeVisits.com has a helpful one page review about insurance reimbursement.
• The Massachusetts Breastfeeding Coalition has information about the Affordable Care Act.
In Massachusetts, if you have problems with insurance, you can register a complaint with:
Joseph G Murphy, Commissioner of Insurance
Division of Insurance
1000 Washington St. Ste. 810 Boston, MA 02118
877-563-4467 toll free.
We’re hopeful that the health care system will get more familiar with breastfeeding support. Then this will be clearer to insurers and consumers alike.