Insurance coverage for lactation services
You have a right to lactation coverage! As ordained by the Affordable Care Act, health insurance plans “must provide breastfeeding support, counseling, and equipment for the duration of breastfeeding. These services may be provided before and after birth”. Unfortunately, insurance companies occasionally find loopholes to deny coverage of services. I highly recommend calling your insurance company prior to our visit to check on individual coverage, and to find out what specific information or forms they require. The National Women’s Law Center has a great script to follow (page 8).
Your insurance company may ask for a provider ID, procedure code(s) and a diagnosis code - which I’ve outlined below - along with the date of service and amount paid.
NPI: 1447744313
IBCLC Credential: L-310853
A procedure code for the type of appointment (CPT code): S9443 and/or 99404
A diagnosis code (ICD-10 code): Z39.1
Superbill
After our visit, I will provide you with a Superbill, which is a specially formatted invoice with the above codes that your insurance company will recognize as lactation-specific. You will submit this to your insurance company for reimbursement of services. Typically this process takes around 2-3 weeks. If the claim is denied or only partially covered, keep trying! Insurance companies often rely on the fact that people won’t bother to fight for coverage, so please be persistent. By law, you have a fundamental right to lactation support. My lactation colleagues and I are fighting the good fight to ensure that happens on a grander scale.