Insurance Coverage for Lactation Consultations

I get asked everyday whether or not Milky Way participates with any insurance companies.  The short answer is “No.”  Although many of my clients get reimbursed for their consultation fees, I am not a preferred provider with any insurance company.

By the end of this year, every new mother’s insurance should cover at least one lactation-related visit.  The Affordable Care Act dictates that all insurance companies must offer this, at no charge to the mother.  This sounds great, but the reality is not so perfect.

Currently, to the best of my knowledge, there are no IBCLC’s (international board certified lactation consultants) in Southern Maryland who participate with any insurance companies.  In fact, there are only a few throughout the country.  The insurance companies have been slow to figure out how to begin credentialing lactation consultants.  In addition, many LC’s, like myself, are hesitant to begin working with the insurance companies.  So far, the rates offered to LCs have been far below what we normally charge.  In addition, the billing is so complicated that even our professional organization has recommended that we will need to hire a billing service.  Finally, no rates have been developed for home visits.

I do not want to cut the level of service I offer clients.  If I begin participating with your insurance,  I will not be able to see you as quickly since I will have to confirm your insurance participation ahead of time.  In addition, I won’t be able to spend as much time with you because I will have to cram more clients into my day to make up for the financial losses and the new fees I must pay a billing service.  Finally, if I participate with your insurance, I will have to limit or discontinue home visits since they are not currently paid at a higher rate even though they take much more time.

I hope that all of these issues can be remedied in a way that helps everyone.  However, that process is likely to take months, if not years.  So what do you do if you need a lactation consultation now?  Many of my clients receive reimbursement after the visit, simply by submitting the superbill I give to their insurance companies.  However, you won’t know for sure if this is going to work unless you speak to the insurance company ahead of time. I recommend these steps:

1. Call your insurance company and ask about your coverage.

2. If you are told that you must see a participating provider, ask for a list of providers and make sure you are actually getting IBCLCs.

3. If they can’t give you anyone close to you, then tell them you need “in for out” coverage or coverage for a non-participating provider.

4. If you submit and your claim is rejected, resubmit and challenge the decision.  Insurance companies are notorious for rejecting a few times before finally paying.

5. If all this seems like too much trouble, consider just paying for the lactation consultation and worrying about it later.  After all, if you don’t breastfeed, you are going to be throwing away a lot more than $125 on formula in just the next few weeks—and nobody is going to reimburse you for that!

6.  Finally, I never turn anyone away for inability to pay.  If you truly cannot afford the consultation, let me know, and we will work something out.



Origins of the Milky Way

People frequently ask me how I came up with the name Milky Way for my business.  More than 18 years ago my husband and I were sitting on our sofa discussing my new business plan as a lactation consultant.  My husband thought I should have a newsletter and immediately came up with the name Milky Way News.  I never did start a newsletter, but Milky Way stuck because it was appropriate in so many ways.

Our children had called breastfeeding “having milkies” as toddlers.  Many families invent code words for breastfeeding as babies become verbal.   I was always turned off when I heard mothers asking if their children wanted “the boob.”  So when my daughter asked for “milkies” when she was about 15 months, we all latched on to it!  In our household, breastfeeding was called milkies ever after.

In addition, the Milky Way galaxy, according to ancient Greek mythology, was started by breastmilk spraying from the breast of the goddess Hera.  In Roman mythology it was the breastmilk of the goddess Ops.              .

Finally, at that time, few people had even heard of a lactation consultant, and many were not even familiar with the word lactation.  Using the word breast in my business name might have given me problems with print media, and some people would have found it to be too “in your face.”  Milky Way sounded to me like a non-offensive and yet beautiful suggestion of a lifestyle with breastfeeding as an integral part.  I liked that, and hoped that my business would be able to promote breastfeeding as part of a normal life with babies.

If you search the internet today, you will find all kinds of breastfeeding businesses which use Milky Way as part of their name.  Sometimes that bothers me, and I feel like saying “hey, I had it first” but, of course, the candy bar was around long before me!  I try to take it as a compliment that others realize how appropriate the name Milky Way is.

So, I guess my kids and my husband get much of the credit for the invention of the Milky Way name, but I have done my best to make sure that the name means quality breastfeeding help in Southern Maryland to all who hear it.  I’m glad I didn’t go with my husband’s second choice:  Little Suckers!  What do you think?