Could my lactation services or breast pump be covered by insurance?

Could my lactation services or breast pump be covered by insurance?

This is such a common concern!

Love it or hate it, the Affordable Care Act is great for breastfeeding!  Breast pumps are a required benefit but your company could provide you with the best pump available or a simple hand pump.  Covering lactation services is also a required benefit but insurance companies are still sorting out what this means.  However, more and more of our clients are receiving insurance reimbursement for a private consultation or going back to work class, so submitting a claim and appealing initial denials are always worth the effort.  Even if the services are not covered by insurance, the claim should be reimbursable if you have a Flex Spending account.

Five steps to insurance reimbursement

1. Contact your insurance company- Find out what your benefits are under your plan. Ask what codes are covered. The most common codes we use are Z39.1 Maternal lactation care and 99404-33 Breastfeeding counseling. There are many diagnoses codes we use as well but until we see you, we won’t know what these might be.
2. Get approval or the appropriate referral from your doctor if possible.
3. See us! Many people are not sure if insurance will cover your visit with us but know that our high-quality service is worth every penny that they are spending. However, getting your ducks in a row first helps with getting reimbursed later.
4. Ask what the process is to submit a claim with your insurance company.
5. Submit 3 times if needed. Many people who have been told my services wouldn’t be covered have gotten reimbursed by being the squeaky wheel. Once a claims adjuster has seen my bill 3 times, it is often cheaper at that time to provide some reimbursement. We encourage you to make 3 copies of all the paperwork and just keep mailing them in if the claim is rejected.

Providing you with a hospital receipt with diagnostic codes makes it more likely that our clients will be reimbursed by insurance and we are happy to provide this service.

The overwhelming amount of scientific evidence on the benefits of breastfeeding has been influencing many insurance companies to include breastfeeding related costs into their benefit plans.  They will often cover International Board Certified Lactation Consultant services or the purchase of a breast pump.  Unfortunately, the coverage varies widely under different insurance plans.

For more information, you may also visit: http://www.aap.org/breastfeeding/files/pdf/CODING.pdf