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Home Visits and Insurance

line hand holding up infant

For home visits with an IBCLC, here’s a summary of  who will cover the cost and who will reimburse for the cost. First, it’s necessary to define coverage and reimbursement.

Coverage means the service is included in your plan. You do not pay out of pocket because, essentially, you have already paid.

Aetna is the only company in the United States that covers IBCLC home visits. They have a list of preferred providers, there are several in Massachusetts. Contact one of them and there will be no out of pocket cost to you.

Reimbursement means you pay out of pocket (credit card, check, cash) for the service. You submit a detailed receipt, provided by the IBCLC, and get your money back in about a month.
Three companies that reliably reimburse for IBCLC home visits are:

• Harvard Pilgrim Health Care
• Tufts
• Blue Cross/Blue Shield of Massachusetts.
Harvard Pilgrim and Tufts have recognized the value of lactation support for years, even before the Affordable Care Act mandated continued support. Blue Cross/Blue Shield joined their ranks more recently.

There have been irregular reports of reimbursement from other companies.

Find out what kind of lactation support your insurance company provides. They may not understand what or why that is important.  It helps to start the conversation. For example, several IBCLCs, as part of a licensure effort, were able to talk with administrators from BC/BS of Massachusetts. The lactation consultants explained why mothers need IBCLC support after they leave the hospital. The administrators came to understand the value of this continuing care. As a result, Blue Cross/Blue Shield of MA has been providing reimbursement. They have a list of many IBCLCs in Massachusetts who make home visits.

What about women who have MA Health or other Medicaid plans? Those plans require a licensed health care professional. For example, you can see a doctor or nurse, both licensed health care providers, in an office. However, it won’t cover or reimburse for an IBCLC visit at home.

Although doctors and nurses are licensed, their training and experience in lactation is not as thorough. There is a difference. An IBCLC is a lactation specialist with an internationally recognized certification. However, we are not (yet) licensed in MA.

It simply is unfair that all families cannot receive the benefit of an IBCLC home visits, especially low income families. This is an obvious disparity in health care. For this purpose, my colleagues and I advocate for licensure of IBCLCs. It’s a state-by-state endeavor. We’re still working on it in Massachusetts.

Here’s the insurance situation for IBCLC home visits:
• Aetna provides full coverage.
• Harvard Pilgrim, Tufts and Blue Cross/Blue Shield of MA will reimburse.
• Some other companies may, you have to research that.
• Every family deserves access to IBCLC lactation support.

The artwork is a detail from a painting by Barbara Swan. This painting hung in my mother’s bedroom for my decades.