Insurance Reimbursement of Lactation Expenses

The Affordable Care Act (ACA) of 2010 expanded Women’s Preventative Services to include breastfeeding support, supplies, and counseling at no copayment, coinsurance or deductible for these services on plans that are compliant with the ACA.  However, women with eligible plans have been encountering problems accessing these reimbursements, or are being charged copayments, coinsurance, or deductibles and must stand up for their access. A 2015 report from the National Women’s Law Center states that many insurers are, in fact, violating the law by failing to properly cover breastfeeding supplies and support.  In fact, class action lawsuits have been making their way though the court systems.

The following links are a compilation of resources and tools to help you get the coverage you are entitled to if your plan is ACA-compliant.

  • How To Find Out If Your Health Plan Is Covering Women’s Preventive Services with No Co-Pay, as Required by the Health Care Law from the National Women’s Law Center.
  • The National Women’s Law Center has put together an authoritative toolkit and letter templates to help. Take the time to read them and they have a Cover Her hotline where you can go for more assistance determining your coverage.
  • This infographic we put together may help you determine your coverage as well.

IBCLC Lactation Consultations

  • Do not be surprised if your insurance company is not able to give you the names of any in-network lactation consultants, or only refers you back to the hospital where you gave birth (where there may or may not be any credentialed lactation help available), or even refers to your baby’s physician who may not have had any training in lactation. When selecting an independent IBCLC lactation professional, it is helpful for mothers work with one who can provide them with a “superbill” that can be used to submit  claims.  It is also helpful to have the baby’s doctor provide or sign a Referral for Lactation Visit.
  • Call your insurance provider to verify the process for submitting an insurance claim.  Be sure to make and keep copies of all the paperwork/receipts/superbills/referrals you send them. Your insurer may have a filing time limit, so be sure to file within that time frame, and be sure to follow-up and check-in on receipt and processing.  It is normal for it to take 4-6 weeks to process. There are resources for filing the claim in the toolkit from NWLC linked above.
  • What to Do if a Health Insurance Company Denies Your Claim, State of Illinois, Department of Insurance.
  • The ACA ensures your right to an internal appeal and to request an external review if your internal appeal was unsuccessful.

Breastpumps

  • Here is a letter template from the National Women’s Law Center to use if your insurance plan is non-grandfathered and does not provide you with a process for obtaining a breast pump.
  • The National Women’s Law Center also has compiled a toolkit entitled Getting the Coverage You Deserve: What to Do If You Are Charged a Co-Payment, Deductible, or Co-Insurance for a Preventive Service that has PDF and DOC letter templates and instructions on what to do if you have been charged a co-payment or deductible for an eligible service or product. Templates for breastpumps are available on pages 32/33 of the PDF file and pages 15/16 of the DOC file.