Insurance Reimbursement Update

It has been almost 3 years since I wrote about insurance coverage for lactation services. A lot has changed in that time.  Most insurances will now provide new mothers with an electric breast pump as soon as the baby is born, if not before, at no cost to her.  The insurance plans now comply with the Affordable Care Act when it comes to breast pumps.  However, coverage for lactation help is still spotty.

Insurances which otherwise must abide by the Affordable Care Act are required to cover lactation services as well.  Some of my clients have found, though, that when they inquire about this coverage, they are given several excuses of why they will not be reimbursed for a lactation consultation.  The most common excuses are

1.  We only cover lactation services while you are in the hospital

2.  We only cover services provided by a licensed provider

3.  We only cover services provided by in-network providers

Luckily, the Federal government has gotten wind of these excuses and is putting a halt to them!  In October of 2015, the US Department of Labor published a document that addressed these excuses and other concerns about preventive services covered by the Affordable Care Act.  You can read the document yourself at

If you don’t want to read the whole thing, however, then here are the most important facts to know when you discuss this with your insurance company.

1.  Insurers must provide coverage for lactation services for THE DURATION OF BREASTFEEDING.  That means they must cover it if you need help at any point while you are breastfeeding, not just in the hospital.

2.  There is only one state in the United States which currently offers licensing for lactation consultants.  Insurers may not refuse to cover for an unlicensed provider, so you should be covered to see an IBCLC (International Board Certified Lactation Consultant).

3.  Insurers must provide coverage for out-of-network providers if they have no in-network providers in your area.  This is usually the case as there are very few in-network lactation consultants around the country, and, currently,  none in Southern Maryland.

This is all good news, but it doesn’t mean that dealing with the insurance company is always easy.  You still need to pay up front and then submit for reimbursement from your insurance company.  I’m sure you will agree, though, that that is a small price to pay for expert help in your home when you most need it!

The Affordable Care Act has definitely changed insurance company involvement in breastfeeding, but one thing remains the same.  Expert lactation help is worth the investment.  Even if you have to pay for it, it will more than pay for itself as you save on formula and doctor’s visits.  And who can put a price on peace of mind?