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. You can contact Aetna or ask the IBCLC that you call if they are an Aetna provider. I will soon be an Aetna provider in the Ellsworth, Maine area.
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. I work with a billing specialist who can submit the claims for you, if you would prefer.
Three companies that reliably reimburse for IBCLC home visits are:
• Harvard Pilgrim Health Care
• Blue Cross/Blue Shield of Massachusetts. (BC/BS)
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, members of the Massachusetts Lactation Consultants Association spoke with administrators from BC/BS of Massachusetts. The lactation consultants explained why IBCLC support is still needed after a mother leaves the hospital. The administrators came to understand the value of this continuing care. As a result, BC/BS of MA began providing reimbursement for IBCLC home visits in November 2016.
What about women who have a Medicaid plans? Those plans require a licensed health care professional. This means 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.
That’s because doctors and nurses are licensed providers. However, their training and experience in lactation is not as thorough. An IBCLC is a lactation specialist having completed lactation specific education and clinical, one-on-one experience with mothers and babies. The IBCLC is an internationally recognized certification, though not a license. IBCLCs are licensed only in Georgia, Oregon, New Mexico and Rhode Island. It’s a state-by-state endeavor.
All families should be able to receive an IBCLC home visit. That low income families don’t have this benefit is an obvious disparity in health care. This is one reason I advocate for licensure of IBCLCs.
In short, 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 ask about reimbursement for lactation support.
• Every family deserves access to IBCLC lactation support.
Good luck and feel free to keep in touch.
Note: The artwork is a detail from a painting by Barbara Swan. This painting hung in my mother’s bedroom for decades.