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  • Sharon Mattes

Insurance Payment for Lactation Services


Looking for a Lactation Consultant provider who will ‘take your insurance’? That is Not how this works! Here’s what you can do: Step 1) Call your Insurance Company. Ask for a referral to a Lactation Consultant ‘in your Network’ who will be able to see you in your home after birth. If they are unable to give you a list of names of (IBCLC) International Board Certified Lactation Consultants [which is the ‘Gold Standard’ in Lactation care], within 50 miles, you can then go to: Step 2) Find a local IBCLC (there are 3 at Natural Beginnings) who'll make the appointment, and while at your home or office visit, will provide a ‘Super Bill’ (Insurance Reimbursement Form) with the required CPT Codes for you to submit to your insurance company. They will then reimburse you for these 'out of Network' expenses. Or you can go to ILCA's link by zip [International Lactation Consultant Association] to Find A Lactation Consultant in your area.

The Affordable Health Care Act requires insurance companies to allow you to use us as ‘out of network providers’ if they are unable to offer you a list of consultants to choose from. You might be given names of ‘other’ professions who know about breastfeeding, but are not specialty-trained or experienced in this field. Insurance companies may refer you to: Physician’s Assistants, Lactation Nurses, Breastfeeding Specialists. These professionals may or may not have the necessary skill and/or qualifications to help you in correcting these complex breastfeeding issues.

Ask if these referrals are IBCLC Certified. Be assertive when asking for what you really want and need. Don’t allow an insurance clerk ‘give you the runaround’, by saying they can’t find this type of support for you. It is available. Sometimes you just need to ask for a Supervisor. There are plenty of IBCLC’s out here waiting to help you. Professional Lactation Consultants are often small-business owners in private practice who are happy to do in-home or in-office Lactation visits! Call them – they’ll work with you to get reimbursment for their services!

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