Insurance Essentials:
Always call your insurance to verify your coverage - before your visit!
1. Are your visits covered at 100%?
2. Have you and your baby met your deductible?
3. Do you or your baby have cost sharing?
2. Number of visits allowed?
3. Are telehealth visits covered?
4. Are you required to get a referral before the visit? (from your pediatrician)
5. Is a prior authorization required? (initiated by your pediatrician)
*When booking, please email me your insurance information and photos
Accepted In-Network Insurances:
Aetna
We can accept most Aetna insurance policies. They’ll usually pay for 6 visits or 6 codes (3 visits) depending on your specific policy. Telehealth visits are not covered.
Tricare
We accept Tricare policies. They’ll generally pay for 6 visits. Telehealth visits are not covered.
United Healthcare
We accept most United insurance policies. The number of visits is dependent on the specific policy. Telehealth visits are not covered.
Accepted Insurances In-Network through Third Parties:
We accept some insurance plans through third-party companies who file your claims for you. Most of the time visits are covered at 100%. However, occasionally, deductibles and cost sharing apply. All insurance companies have disclaimers that coverage decisions are made when claims are received. In the extremely rare event that your insurance does not cover a visit, then payment would become the responsibility of the family.
Cigna (through Wildflower)
We accept Cigna through Wildflower. Please follow the link below to submit your insurance information for approval.
https://portal.wildflowerhealth.net/affiliate-care/acdcf8e
The Lactation Network (TLN):
We accept the following insurances through TLN. Please follow this link to submit your insurance information for approval. https://go.lactationnetwork.com/WhateverWorksLactation
Curative Health
First Choice Health
Must have First Choice Health logo on their card
Imagine Health
Meritain
Multiplan
Must have Multiplan logo on their card
Provider Network of America (PNOA)
Most PPO plans cover lactation visits.
Sutter Health
Veterans Affairs Community Care Network (VACCN) – Optum East
Velocity
Out-of-Network Insurances:
Any insurance policy other than the ones listed above are Out-of-Network and self-pay. The fee would be collected in full at the time of the visit. You would receive a receipt (called a superbill) to file your claim for reimbursement. * Travel fees are not reimbursed by insurance.
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).