Nurturing Traditions fights hard to obtain insurance coverage for as many clients as possible. However, some insurance plans will not contract directly with lactation consultants and we are not able to bill them directly. In these situations, parents can submit a superbill to their insurance for reimbursement.
As a new or expecting parent, battling with your insurance company is the last thing you have time to do. But you pay for your health insurance. At the minimum, they should cover what is required by law!
You have a right to coverage!
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. In 2015, the United States Department of Labor clarified some ambiguity in the Affordable Care Act.
What to say…
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). Your insurance company may need the following…
Provider number: 1972883296
Procedure codes: 99404 and S9443
Diagnosis code: Z39.1.
Ask your insurance company to provide a list of lactation consultants within 60 minutes of you who are in network. It’s unlikely they can do this. In this case, you can ask for GAP coverage, meaning they’ll bill an out-of-network provider as an in-network provider.
Keep fighting!
Especially in Michigan, where IBCLCs (International Board Certified Lactation Consultants) are scarce, insurance companies sometimes find loopholes and deny coverage of services. This doesn’t mean all is lost, but it does unfortunately mean more work for parents. Insurance companies rely on the fact that people won’t bother to fight for coverage. Some insurance experts say it can take 4 submissions of a claim before insurance pays.
It’s worth it.
If for some reason your insurance company does not cover the cost of our services, I want to assure you that in paying out-of-pocket, you will be receiving the best breastfeeding support available in our area. We are passionate about what we do, we care deeply about supporting families in meeting their breastfeeding goals, and we strive for excellence in our work. You will not be disappointed!
