Insurance Coverage of IBCLC Care

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Insurance Coverage of IBCLC Care

The Affordable Care Act states, “Health insurance plans must provide breastfeeding support, counseling, and equipment for the duration of breastfeeding. These services may be provided before and after birth.” The only exceptions to this are state funded health care plans and grandfathered plans. Especially in Michigan, where IBCLCs (International Board Certified Lactation Consultants) are not yet licensed and are scarce, insurance companies sometimes illegally deny coverage of services.

Some insurance companies such as Violet_(transparent_background), MESSA, BCBS of Illinois, Cofinity, Connect Care, and Cigna tend to make lactation coverage easy. They follow the law and parents are able to have IBCLC services covered at no cost or trouble. Other insurance companies, such as Blue Cross Blue Shield of Michigan and Blue Care Network, routinely deny coverage. This does mean all is lost, but it does unfortunately mean there may be a fight. Thankfully in October 2015, the United States Department of Labor clarified some ambiguity in the Affordable Care Act stating that all insurance companies must provide parents with a list of in-network lactation counselors. If this isn’t possible (and in the Midland, MI area, there are currently no in-network IBCLCs), they must cover an out-of-network provider.

When contacting your insurance provider to check coverage, The National Women’s Law Center has a great script to follow (available on page 8 of this document). Should you have any trouble, please contact the National Women’s Law Center according to the script. If your insurance company asks, my provider number is 1972883296. I generally use the procedure codes 99404 and S9443 and the diagnosis code Z39.1.

As a new or expecting parent, I know battling with your insurance company is the last thing you have time to do. But taking the time to do this will help pave the way for other families to receive the breastfeeding support they deserve. I am willing to help in any way I can and continue to fight for insurance coverage in Michigan!

If for some reason your insurance company does not cover the cost of my services, I want to assure you that in paying cash, you will be receiving the absolute best breastfeeding support in our area. I am passionate about what I do, I care deeply about supporting mothers in meeting their breastfeeding goals, and I strive for excellence in my work. You will not be disappointed!

Update: More clients have been receiving reimbursement through BCBS of Michigan. It is taking a few phone calls, a letter, and around 2-3 resubmissions. Please let me know about your experience. I’m currently gathering stories to aid in filing a complaint with the Michigan Department of Insurance and Financial Services. The United States Lactation Consultant Association is also in the process of gathering information for a class action lawsuit against insurance companies denying care. Some states have won the battle and BCBS is easily covering lactation consultations, in compliance with the law. There is hope!

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About the Author:

Leah Segura has been working with breastfeeding parents in the MidMichigan area for over a decade. She works as an International Board Certified Lactation Consultant (IBCLC) in private practice and volunteers through several organizations, advocating for parents in her community.

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