***Important Note on Insurance***
Please call your insurance company BEFORE your visit and ask the following questions:
1. Does your specific policy cover lactation visits and is there cost sharing?
2. How many lactation visits are allowed?
3. Are telehealth lactation visits covered?
4. Is a referral required before your visit? (from your pediatrician, obstetrician, midwife, or primary care provider)
5. Is a prior authorization required?
(it would be initiated by your provider in the same way above)
(see Affordable Care Act (ACA) information below)
***Important Note*** I need photos of your insurance card and your baby's insurance card. Please email them to me after you book your appointment.
In-network insurance
Aetna
We can accept most Aetna insurance policies. They’ll pay for 6 visits or 6 codes (3 visits) depending on your policy. Virtual visits are not covered.
Tricare
We accept Tricare insurance. They’ll generally pay for 6 visits.
In-Network insurance (through a third-party)
I use a third-party company to be able to accept more insurance plans without copays, coinsurance, cost sharing or deductibles. Third-parties have agreements with certain insurance companies to cover the number of lactation visits that your policy allows. In the extremely rare event that your insurance company does not cover the visit, then you would be responsible for the self-pay rate.
Cigna (through Wildflower)
I use the third-party Wildflower in order to take Cigna. Please follow this link to submit your insurance information. https://portal.wildflowerhealth.net/affiliate-care/acdcf8e
In-Network insurance through The Lactation Network (TLN):
For any of the insurance plans below, I use the third-party TLN. Please follow this link to submit your insurance information. https://go.lactationnetwork.com/WhateverWorksLactation
First Health
First Choice Health
Imagine Health
Multiplan
If your insurance card has this logo down below on it, then your plan may cover your lactation visits.
Provider Network of America (PNOA)
Most plans cover lactation visits.
Sutter Health
United Healthcare (UHC)
Most PPO plans cover visits. However, United is not paying for telehealth visits at this time.
Veterans Affairs Community Care Network (VA CCN) East
Velocity
Out-of-network insurance
Any insurance policy other than the ones listed above are out-of-network. You would be self-pay, and the fee is collected in full at the time of the visit. We’ll give you a receipt (called a superbill) for you to submit a claim to your insurance company, and they will reimburse you directly. Please note that travel fees apply, and they are not reimbursable by insurance.
***Important Note*** Please call your insurance company to check your lactation services coverage before your visit.
Methods of payment
Credit, FSAs, and HSAs are the preferred methods of payment. Lactation services and supplies are reimbursable with FSAs and HSAs.
No insurance?
If you don’t have insurance and have special circumstances or hardships, please send me a message at 919-229-9266 or ashley@whateverworkslactation.com.
Affordable Care Act (ACA) & Lactation Services
The Affordable Care Act (ACA) is a law that was enacted in 2010, under the Obama administration, that requires health insurance companies to pay for preventive care including lactation services and breastfeeding supplies. Under the ACA, lactation services are required to be covered in full without copayments, cost sharing, coinsurance, or deductibles. Some grandfathered insurance plans are not required to comply with this law. Additionally, the reality is that there is little oversight or enforcement of the law. Lack of oversight has allowed many, many insurance companies to interpret the law to their advantage. Some insurance companies require referrals and prior authorizations in order to cover lactation services which delays and deters families from getting coverage. Additionally, many insurance companies have interpreted and limited the meaning of a "qualified healthcare professional" within the wording of the ACA. They have determined a "qualified healthcare professional" only includes physicians, physician assistants, nurse practitioners, and midwives - they do not and will not include lactation consultants. This is extremely important for lactation services coverage because it means insurance companies will not contract with lactation consultants to be in-network providers. It unjustly causes most families to be forced to pay for lactation services out-of-network with significant out-of-pocket costs.
Here's a deeper look into government and organizational support for lactation services:
The Health Resources & Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services (HHS), states: "Under the ACA, most private health insurers must provide coverage of women's preventive health care – such as mammograms, screenings for cervical cancer, prenatal care, and other services – with no cost sharing. Under section 2713 of the Public Health Service Act, as modified by the ACA, non-grandfathered group health plans and non-grandfathered group and individual health insurance coverage are required to cover specified preventive services without a copayment, coinsurance, deductible, or other cost sharing, including preventive care and screenings for women as provided for in comprehensive guidelines supported by HRSA for this purpose."
The HRSA has a cooperative agreement with the American College of Obstetrics and Gynecologists (ACOG), a professional association of ob-gyn and other professionals, which formed a panel of experts who developed guidelines called the Women's Preventive Services Initiative (WPSI). The HRSA states that "WPSI recommends comprehensive lactation support services (including consultation; counseling; education by clinicians and peer support services; and breastfeeding equipment and supplies) during the antenatal, perinatal, and postpartum periods to optimize the successful initiation and maintenance of breastfeeding.
Breastfeeding equipment and supplies include, but are not limited to, double electric breast pumps (including pump parts and maintenance) and breast milk storage supplies. Access to double electric pumps should be a priority to optimize breastfeeding and should not be predicated on prior failure of a manual pump. Breastfeeding equipment may also include equipment and supplies as clinically indicated to support dyads with breastfeeding difficulties and those who need additional services."
National Women's Law Center states:
"The health care law requires all new health plans to cover 'comprehensive prenatal and postnatal lactation support counseling.' This means that breastfeeding mothers have health insurance coverage for lactation counseling without cost-sharing for as long as they are breastfeeding. Lactation consultants are trained specialists who work with women to help them begin and continue to breastfeed. Health insurers must cover such consultations without cost-sharing but can require consumers to see only the providers on their list, called 'in-network providers,' or impose other requirements on coverage."
- National Women's Law Center - New Benefits for Breastfeeding Moms: Facts and Tools to Understand Your Coverage under the Health Care Law
Lactation Supplies are Medical Expenses per IRS
"All new health plans must cover breastfeeding equipment and supplies 'for the duration of breastfeeding' without cost-sharing, which means plans may not apply any co-payment, co-insurance, or deductible to these benefits. Breastfeeding equipment and supplies most commonly refers to a breast pump, which is a device that extracts milk from a lactating woman, and related accessories. The FDA, which regulates breast pumps, states that they can be 'used to maintain or increase a woman’s milk supply, relieve engorged breasts and plugged milk ducts, or pull out flat or inverted nipples so a nursing baby can latch-on to its mother’s breast more easily.' Many women use breast
pumps to express and store their milk after they have returned to work, are traveling, or have to be away from their breastfeeding child. (Also, employers are required to provide a clean, private place for women to pump while on the job.) While a health insurer must cover breastfeeding equipment and supplies, it can impose some requirements on this coverage, such as requiring a purchase, rather than rental, of a breast pump. "
- National Women's Law Center, National Women's Law Center - New Benefits for Breastfeeding Moms: Facts and Tools to Understand Your Coverage under the Health Care Law
"You can include in medical expenses the cost of breast pumps and supplies that assist lactation. This doesn’t include the costs of excess bottles for food storage."
- Official US Government IRS (Internal Revenue Service) website Publication 502 (2021), Medical and Dental Expenses | Internal Revenue Service (irs.gov).