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Birth to Breast
Affording an IBCLC
Because of the Affordable Care Act, every insurance is required to cover lactation support. On this page, you will learn what free lactation support groups exist, what IBCLCs take what insurance, & insurance information on ways you can have your insurance cover a visit with an out-of-network IBCLC.
Insurance information
Common insurances and my experiences with them (may not be accurate to you)
Tricare prime and select
Parents with Tricare Prime and select have the option for in-network and non-network providers. In-network providers bill Tricare directly for you, and the only cost you may face is a travel fee for home visits. Non-network providers may charge higher rates so that you may have some out-of-pocket costs and a travel fee for a home visit. Non-network providers may or may not bill Tricare for you. If they require you to bill Tricare, you will pay the consult out of pocket, and the provider will give you a superbill, which you will have to submit to Tricare for reimbursement. To find a provider, you can search Tricare's website. Tricare covers 6 lactation billing codes. This can be 6 one-hour consults or 2-3 90-minute to 2-hour consults.
Aetna PPO
Patients with Aetna PPO may get 3-6 covered consults (possibly more with out-of-pocket cost) with an in-network provider, but this depends on their situation. It is always recommended that you call your insurance company to see if they have some specific information for you. Some Aetna plans may let you use an out-of-network provider, but may have some requirements like meeting your deductible or preauthorization. Doing this often requires paying out of pocket and seeing if insurance will reimburse you.Travel fees for home visits are never covered by insurance.
United Healthcare PPO
Patients with UHC often get 6+ covered consultswith an in-network provider but this depends on their specific situation. It is always recommended to call your insurance to see if they have some specific information for you. UHC has partnered with The lactation network. A huge benefit to this is there is no co-payment. Travel fees may still apply and are not covered by insurance eor the lactation network.
Anthem blue cross PPO, Blue cross PPO, Blue shield PPO, ChampVA
The lactation network is a service that offers usually 6+ covered visits for parents who qualify.
Cigna
Cigna typically offers 6+ lactation consults with no co-pay as long as the client is approved before booking. Travel fees are not covered if applicable.
Options if your unable to use insurance
Superbill
This option may work for most PPO insurances and Tricare. For this option, the client pays the lactation consultant out-of-pocket, and the lactation consultant then sends the superbill to their provider for reimbursement. The health insurance may occasionally ask for a statement from the client stating why they couldn't see anyone in-network and a letter of necessity from the baby's pediatrician. You would then follow your insurance provider's steps to submit an out-of-network claim.
Gap coverage
Gap coverage is an option used primarily for PPO insurance. For this option, you would call your health insurance ahead of time and request to see an out-of-network provider. The Out-of-network provider must be willing to bill your insurance directly. If your insurance does not pay out, you will still be responsible for the consultation cost.
Flexible spending accounts/Health Spending accounts
Using a flexible spending account or health spending account is typically an option for PPO insurance and can be a great one for families with United Healthcare. You would pay for your consultation with your flexible spending account card. Requesting a superbill can be handy in case your insurance wants more information.
In-network provider
An in-network provider is a provider who has signed a contract with your insurance company. They agree not to charge any insurance-covered fees to the client unless the insurance company states they owe it on the EOB. An in-network provider will also submit your claim directly to insurance.
The lactation network
The lactation network is a company that contracts with Lactation consultants and bills your insurance. They guarantee a number of covered consults (not including travel fees) for families. Usually, PPO plans are accepter through them.
Support group
Lactation support groups are often led by lactation consultants and are a place to talk to other parents and lactation professionals. These are great when you are pregnant or postpartum and have simple lactation questions or just want to meet other parents in the same stage. Groups can be in-person or virtual. When in person there may be a scale for you to use. Googling lactation support group + near me can help you find one.