LACTATION CONSULTANTS & INSURANCE REIMBURSEMENT.
After spending the last few years in the world of Insurance Reimbursement for Lactation Services, I have updated the information on my website about this topic. It had me thinking about my strong feelings related to this whole topic and I decided to get more personal and write about it and that led to me wanting to do a show about it. When it comes to Healthcare in the United States as it relates to lactation services, it is pretty piss poor. This is a hot topic and one that I have to respond to on a daily basis to moms that call up for breastfeeding help. With the Affordable Care Act, and with what Insurance companies are claiming, the expectation is that they can get help from lactation consultants like myself and rent hospital grade pumps like I rent and not have to pay out of pocket for these services or products. Based on what parents are told, I can easily understand why they might think this. However, there is what parents are told & then there is the truth of the situation. Here is the letter I have written that you will see when you come upon my website – aabreastfeeding.com or allaboutbreastfeeding.biz
As a working woman and mother of 3, I know the financial burden having a new baby can be on the families budget. You may have come upon this page because you are looking to hire me as your lactation consultant. Since you have heard that insurance companies are covering lactation services, but perhaps cannot get the answers you need from your insurance company, you have come to this website to try and find out if you can make an appointment with me for lactation help and not have to pay out of pocket.
If you are like most mothers who have insurance coverage, you more than likely expected to be given a list of names (IBCLCs in your area) that you could make an appointment with for lactation help. You quickly find out that your insurance company tells you that while they will cover lactation services, they do not have names of any IBCLCs providing this service. This is confusing to you. They say they will cover it ( although no one guarantees) but they don’t have a list of anyone you can see. If you called up to find the names and numbers of pediatricians, you would be given a list of names and numbers of providers in your area. But this does not happen with IBCLCs.
This is because your insurance company has not contracted with any private practice IBCLC to be in their network. We cannot be a provider for them as they will not accept us in their network. In the state of Arizona, there were over 85,000 births in 2014. In the state of Arizona, there are between 275 and 300 IBCLCs. And yet, less than perhaps 5 or 10 have been accepted into the insurance programs as a provider. In the whole state of Arizona. Where 85,000 mothers gave birth in 2014. This is exactly why you are getting the run around from your insurance company.
I recently applied to a major insurance provider and was denied being a provider as they stated this area was saturated with providers. What??? A handful of IBCLCs have been accepted as providers and the area is saturated? What??? I have applied to other insurance companies and am turned down because they are not offering provider status to IBCLCs. I have been a breastfeeding educator for over 25 years and an IBCLC since 2001 and yet I am denied the ability to become a provider for the insurance companies. Not just me, of course, but my peers also. This is insane.