A mom needs help because she’s struggling with breastfeeding. She calls my office for information and asks if I take insurance. I explain that I do not, and tell her to call her insurance company. Some insurance companies will cover breastfeeding support services, others won’t. She calls her insurance company and is told that consultations with in-network lactation consultants are covered.
Since I am not in-network she then has to decide if it’s worth it to her to pay out of pocket, or should she continue trying to find an in-network lactation consultant (good luck with that I say!)
When calling the insurance company it is essential to know what questions to ask. You must ask questions, and be firm about getting answers. Don’t be shy about asking why, and what is covered or not covered!
QUESTIONS TO ASK YOUR INSURANCE COMPANY ABOUT LACTATION SERVICES COVERAGE:
Please be aware that it’s not just the insurance company you have to question, it’s your individual coverage plan with that insurance company.
Are breastfeeding support services covered? Yes / No
(*keep in mind however that some insurance companies will cover 100%, others will do a partial reimbursement, still others may not pay at all, for various reasons.
Are there approved in-network providers? If not, can I get reimbursed if I use a lactation consultant who is out-of-network?
How much of the lactation consultant’s fee will be covered?
Is there a certain level of consultant I can see? International Board Certified Lactation Consultant (IBCLC) vs Certified Lactation Counselor vs. Certified Breastfeeding Educator?
*If there’s a difference between what my plan covers and what the in-network lactation consultant charges will I be responsible for the remaining balance of the consult visit fee?
If you’re told you will not have to pay the difference between what’s covered and what the lactation consultant charges, please consider this – if an insurance company will only pay a portion of her fee, how does an IBCLC get the rest of the money owed to her?
Does she…spend less time with one patient vs the other because she knows she will get paid less (or more?)
Enter into an agreement (with the patient) wherein the patient will pay the difference (so far the insurance companies I have contacted about becoming an in-network provider specifically state that the lactation consultant must not collect money from the patient.)
Should she risk getting in trouble with insurance companies by collecting part of her fee from the patient?
Should she wait and see how much she is reimbursed and hope she can collect the difference from the patient?
Speaking for myself, I work as a lactation consultant in private practice out of love and my passion for helping mom and babies continue to breastfeed. However, I have to earn money and pay bills. Also, just as any other professional health caregiver does, I have to keep up with the latest advancements and stay up to date with my education. This takes money and time. Lots of money and lots of time.
If I could be assured that I would be fully reimbursed for my professional services I would happily work with the insurance companies. Unfortunately, being fully reimbursed is highly unlikely the majority of the time.
If you need breastfeeding help and support you can go to a Breastfeeding Support FB page, or visit other breastfeeding support forums, talk to other moms, google for information, attend support group meetings, but ultimately find you still need to visit a professional.
Once you’ve decided you’re going to seek professional help and are looking for a lactation consultant (a health care professional specializing in the clinical management of breastfeeding) it’s a good idea to ask:
How long have you been a lactation consultant?
How long have you been in private practice? (practicing in a clinical setting is very different, so this is an important question to ask)
What’s your area(s) of expertise?
Most people are not aware that anyone can call themselves a lactation consultant, so be sure to look for an IBCLC, a lactation consultant that is a Board Certified, Registered Lactation Consultant. “The International Board Certified Lactation Consultant, IBCLC, is the credential that is internationally recognized as the gold standard for lactation care.
When you make an appointment with me you are paying for my professional credentials, background and expertise, as well as ongoing support and care. You are investing in your and your baby’s future health.
So I say, go for the gold, because your health, your baby’s health, your peace of mind, and your breastfeeding relationship, are priceless.