Will Insurance Cover Lactation Care?

Apr 1, 2023
BY Partum Health Care TEam

For many parents learning the rhythms of feeding your infant can be one of the most stressful parts of the early days, weeks, and months. It's also one of the reasons why support from a lactation consultant is an essential part of your care. Research has shown early intervention from lactation experts can help parents achieve better results - whether you're breastfeeding, combination feeding, pumping and bottle feeding, or chestfeeding.

Find your lactation consultant before baby arrives

While getting help from a lactation consultant may seem like a no-brainer, figuring out insurance coverage for your care can be overwhelming and hard to navigate, especially if you're arranging to see a lactation consultant after your newborn has arrived. For this reason we strongly recommend you find an in-network lactation consultant and establish care during your pregnancy. Seeing a lactation consultant before baby arrives helps equip you with the information you need from the first latch in the hospital or birth center. It also makes it possible to then schedule a postnatal visit much more easily since you already have established your medical history and your care as a patient of the lactation consultant.

Will my insurance cover lactation care?

Yes, your insurance should cover lactation care. Here's the facts: in the United States, under the Affordable Care Act (ACA), health insurance plans are required to provide coverage for lactation support and counseling, as well as the cost of renting or purchasing breastfeeding equipment, such as breast pumps.

The ACA mandates that health insurance plans must cover these services without cost-sharing, meaning they should be provided at no additional cost to the insured individual. This seems straightforward, right? Unfortunately there is a big asterisk on this mandate - most insurance companies do offer no-cost share care but ONLY with in-network providers. The exception to this may be grandfathered plans that pre-date the ACA. Specific coverage of course may vary between insurance plans, so it's always advisable to review your policy documents or contact your insurance provider directly to understand the details of your coverage. But with a little preparation and a focus on finding in-network lactation consultants you should be able to make it happen.

How can I confirm what my coverage is for lactation care?

Whether you have Blue Cross Blue Shield, Aetna, United Healthcare, Cigna or another insurance provider, it's always a good idea to call your insurance to confirm coverage before your visit. (Another reason why handling this before you are knee deep in the newborn phase is strongly recommended!). On the call you should:

  • Share the NPI (national provider identifier) of the IBCLC/ lactation consultant you plan to work with
  • If you haven't identified an IBCLC, ask your insurance company for the name and contact information of an in-network provider
  • Ideally ask that provider what CPT codes they most commonly use for pre and postnatal visits (e.g. 99345 is a common CPT code) and provide those to the insurance company
  • Ask if there are any restrictions on the location, length, or number of visits
  • Make sure you document the information you receive in the call along with the reference number

Does Partum Health offer in-network lactation care?

Partum Health is currently in-network with Blue Cross Blue Shield (BCBS), Aetna, and UnitedHealthcare for our lactation care. We aim to help you get the support you need for your feeding journey while utilizing your insurance coverage. Whether you're aiming to exclusively breastfeed, use pumped milk, chest feed or combination feed - breast and bottle, we'd love to care for you and your little one!

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