https://boards.hellobee.com/ Pregnancy, Baby and Parenting blog, by Hellobee en Sat, 11 Apr 2026 21:49:38 +0000 https://boards.hellobee.com/topic/fighting-with-insurance-over-lactation-consultant-coverage#post-2732793 Fri, 05 May 2017 15:50:27 +0000 snowjewelz 2732793@https://boards.hellobee.com/ <p>@littlejoy: probably because they have no clue :meh: </p> https://boards.hellobee.com/topic/fighting-with-insurance-over-lactation-consultant-coverage#post-2732779 Fri, 05 May 2017 15:16:22 +0000 littlejoy 2732779@https://boards.hellobee.com/ <p>@Banana330: They have practicing privileges at two hospitals (2 of my 6 midwives also work within the hospitals) ... BUT, I asked my insurance company who I could work with at those two hospitals, and they told me "any licensed provider that's within our network" - but they don't have a list of providers for lactation care. I'm not kidding, this is the garbage I'm working with. </p> <p>@808love: Sigh - this is exactly what I'm dealing with. Same company (different area). Thanks for sharing ... at least I feel like I'm not alone. AND, I maintain that an MD, pediatrician or whoever else they suggested are not the proper people to manage a complicated BFing journey. My insurance company - usually responsive - hasn't responded for 24 hours now. </p> https://boards.hellobee.com/topic/fighting-with-insurance-over-lactation-consultant-coverage#post-2732619 Fri, 05 May 2017 09:01:56 +0000 Banana330 2732619@https://boards.hellobee.com/ <p>@littlejoy: Are your midwives associated with a hospital. ours have privileges at a local hospital and you can use the lactation consultants there. </p> https://boards.hellobee.com/topic/fighting-with-insurance-over-lactation-consultant-coverage#post-2732562 Thu, 04 May 2017 23:15:54 +0000 808love 2732562@https://boards.hellobee.com/ <p><a href="http://www.chicagotribune.com/news/ct-breastfeed-insurance-met-20150703-story.html" rel="nofollow">http://www.chicagotribune.com/news/ct-breastfeed-insurance-met-20150703-story.html</a><br /> Is this similar to what you are facing?<br /> This is such a bummer to go through! </p> https://boards.hellobee.com/topic/fighting-with-insurance-over-lactation-consultant-coverage#post-2732552 Thu, 04 May 2017 22:14:09 +0000 littlejoy 2732552@https://boards.hellobee.com/ <p>@808love: We aren't delivering in a hospital, which makes this complicated, and impossible (I think). </p> https://boards.hellobee.com/topic/fighting-with-insurance-over-lactation-consultant-coverage#post-2732550 Thu, 04 May 2017 22:12:47 +0000 littlejoy 2732550@https://boards.hellobee.com/ <p>@Madison43: @looch: @DesertDreams88: I am sure that there might be some access to an LC within an MD's office, but with my prior history of specific (complicated) issues, I was referred to this LC who specializes in my kind of problem. Considering most LC's I've encountered don't believe there is such thing as true low supply, I am not inclined to find care somewhere else. </p> <p>Also, I'm not sure I'd have access to an LC at a ped's or MD's office if we didn't see them for general care. We aren't willing to switch care providers at this point, but it's good to know that there might be an option for others. </p> <p>I have Blue Cross/Blue Shield (a huge network), and the fact that they don't have a list of providers makes it extremely hard to navigate this whole situation. They also don't have a list of codes they approve. I can't find a different LC (or a covered physician) if I don't have a list from my insurance company. </p> https://boards.hellobee.com/topic/fighting-with-insurance-over-lactation-consultant-coverage#post-2732530 Thu, 04 May 2017 20:25:04 +0000 808love 2732530@https://boards.hellobee.com/ <p>The baby-care hospital unit doctors (peds?) referred me to an on-site lactation consultant just available during my time in the hospital. Then she made a referral to an outside lactation consultant. I think I had to pay a portion of the outside services, if not all. On-site vs. off-site made a big difference. </p> https://boards.hellobee.com/topic/fighting-with-insurance-over-lactation-consultant-coverage#post-2732526 Thu, 04 May 2017 20:01:13 +0000 DesertDreams88 2732526@https://boards.hellobee.com/ <p>My friend is an LC and she works at an Ob/gyn practice, maybe there's someone like that in your area, if you're willing to switch. </p> https://boards.hellobee.com/topic/fighting-with-insurance-over-lactation-consultant-coverage#post-2732483 Thu, 04 May 2017 17:35:47 +0000 looch 2732483@https://boards.hellobee.com/ <p>@Madison43: same with my old pediatrician's office, one MD was also an LC. </p> https://boards.hellobee.com/topic/fighting-with-insurance-over-lactation-consultant-coverage#post-2732480 Thu, 04 May 2017 17:02:43 +0000 sunny 2732480@https://boards.hellobee.com/ <p>@erinbaderin: my insurance covers massage performed by an MD. So basically it doesn't cover it. 🙄 </p> https://boards.hellobee.com/topic/fighting-with-insurance-over-lactation-consultant-coverage#post-2732479 Thu, 04 May 2017 16:56:33 +0000 Madison43 2732479@https://boards.hellobee.com/ <p>@littlejoy: just food for thought ... 2 of the pediatricians in our old office were certified lactation consultants, so it's not so crazy for them to think that the ped's office wouldn't be an option for you. </p> https://boards.hellobee.com/topic/fighting-with-insurance-over-lactation-consultant-coverage#post-2732476 Thu, 04 May 2017 16:50:28 +0000 Mrs. Pajamas 2732476@https://boards.hellobee.com/ <p>@littlejoy: I went through this as well and ultimately it took so long I was denied for time to appeal. Ugh. But I used this website and their appeal letter/faq sheet. Hope it's helpful and good luck! <a href="http://breastfeedingcenter.org/consultations/how-to-insurance-reimbursement/" rel="nofollow">http://breastfeedingcenter.org/consultations/how-to-insurance-reimbursement/</a> </p> https://boards.hellobee.com/topic/fighting-with-insurance-over-lactation-consultant-coverage#post-2732473 Thu, 04 May 2017 16:43:23 +0000 looch 2732473@https://boards.hellobee.com/ <p>Is there any way she can be made in network for you? I had this come up with my son's speech, basically, if there isn't a provider within a certain mile radius that treats the issue, they may have to make a provider available to you. </p> https://boards.hellobee.com/topic/fighting-with-insurance-over-lactation-consultant-coverage#post-2732453 Thu, 04 May 2017 15:59:24 +0000 littlejoy 2732453@https://boards.hellobee.com/ <p>@Truth Bombs: I emailed them to ask ... typically, I don't need a referral for care, but I understand this might be needed in this case. </p> <p>I am just blown away by the fact they are recommending a pediatrician to diagnose and manage breastfeeding failure. It's laughable. </p> https://boards.hellobee.com/topic/fighting-with-insurance-over-lactation-consultant-coverage#post-2732452 Thu, 04 May 2017 15:58:11 +0000 Truth Bombs 2732452@https://boards.hellobee.com/ <p>@littlejoy: would they cover it if you got your doctor to write a referral? </p> https://boards.hellobee.com/topic/fighting-with-insurance-over-lactation-consultant-coverage#post-2732450 Thu, 04 May 2017 15:55:13 +0000 snowjewelz 2732450@https://boards.hellobee.com/ <p>@littlejoy: I really feel you. So much of this last pregnancy/maternity leave was spent arguing on the phone with insurance till I'm blue in the face!! </p> https://boards.hellobee.com/topic/fighting-with-insurance-over-lactation-consultant-coverage#post-2732446 Thu, 04 May 2017 15:47:48 +0000 littlejoy 2732446@https://boards.hellobee.com/ <p>@snowjewelz: Thanks, I'll ask them for all of this!! :) </p> https://boards.hellobee.com/topic/fighting-with-insurance-over-lactation-consultant-coverage#post-2732445 Thu, 04 May 2017 15:46:55 +0000 snowjewelz 2732445@https://boards.hellobee.com/ <p>@littlejoy: If calls are recorded, I would ask for the reference # to the call. How could they even tell you she was out of network if there doesn't even seem to be an in-network group of LCs they will cover?! Is there any more indepth reading material besides your coverage handbook? I would push them on what they mean by a licensed provider if an LC from the actual official organization don't even cut it. They probably mean they have to be affiliated to a dr/hospital....? But is that in writing on their policies?! </p> https://boards.hellobee.com/topic/fighting-with-insurance-over-lactation-consultant-coverage#post-2732437 Thu, 04 May 2017 15:36:07 +0000 littlejoy 2732437@https://boards.hellobee.com/ <p>@Iced Tea: They're saying 50% because she's out of network ... but now they're saying 0% because she doesn't fall under their specifications for a licensed provider (but she's an IBCLC with the highest certifications/licenses available - literally the best, most-qualified in our area). </p> https://boards.hellobee.com/topic/fighting-with-insurance-over-lactation-consultant-coverage#post-2732436 Thu, 04 May 2017 15:35:03 +0000 littlejoy 2732436@https://boards.hellobee.com/ <p>@snowjewelz: Do you think I should get on the phone with them (which is what they're trying to do)? I'm afraid of not having everything in writing. </p> https://boards.hellobee.com/topic/fighting-with-insurance-over-lactation-consultant-coverage#post-2732429 Thu, 04 May 2017 15:27:48 +0000 snowjewelz 2732429@https://boards.hellobee.com/ <p>The only reason my LC was covered was b/c she worked out of our ped's office two days a week so when I saw her I just pay the office copay! </p> <p>If you have time, I'd totally push it... They usually do just wait for people to give up! </p> https://boards.hellobee.com/topic/fighting-with-insurance-over-lactation-consultant-coverage#post-2732426 Thu, 04 May 2017 15:23:02 +0000 juli7 2732426@https://boards.hellobee.com/ <p>My insurance covered lactation consultants if I saw one at a hospital. It didn't cover home visits (though I know that some insurance companies do if the LC has an NPI number). The LC at the hospital I delivered at was terrible, and I ended up seeing an LC at a different hospital. </p> https://boards.hellobee.com/topic/fighting-with-insurance-over-lactation-consultant-coverage#post-2732415 Thu, 04 May 2017 14:57:08 +0000 Iced Tea 2732415@https://boards.hellobee.com/ <p>Obviously, they are hoping you will just give up. </p> <p>It might help to provide a brief letter from your family doctor stating that they always refer out to an IBCLC for lactation services. </p> <p>If they try to stick with paying just 50% (which sounds like BS, BTW, even my poor coverage plan covered at 100%), you can file an appeal, but I know it's a huge pain in the ass. </p> https://boards.hellobee.com/topic/fighting-with-insurance-over-lactation-consultant-coverage#post-2732411 Thu, 04 May 2017 14:44:03 +0000 littlejoy 2732411@https://boards.hellobee.com/ <p>@Mrs. Lemon-Lime: This is the exact situation I'm in. I assume she would be fighting with insurance ALL of the time, so she asks clients to submit on their own. </p> https://boards.hellobee.com/topic/fighting-with-insurance-over-lactation-consultant-coverage#post-2732403 Thu, 04 May 2017 14:23:37 +0000 Mrs. Lemon-Lime 2732403@https://boards.hellobee.com/ <p>My LC basically told me she couldn't bill insurance directly, but her services were covered. She gave me a receipt with all her credentials for insurance to reimburse. It was $150 or $175, but I never followed up with insurance. </p> https://boards.hellobee.com/topic/fighting-with-insurance-over-lactation-consultant-coverage#post-2732401 Thu, 04 May 2017 14:20:48 +0000 erinbaderin 2732401@https://boards.hellobee.com/ <p>I have no advice, but I want sympathize - my insurance (I'm Canadian so it's totally different, but still) claims to cover acupuncture. But they'll only cover acupuncture given by an MD, which...doesn't exist. It's so frustrating when companies claim to cover something but make it impossible to actually use the coverage. </p> https://boards.hellobee.com/topic/fighting-with-insurance-over-lactation-consultant-coverage#post-2732379 Thu, 04 May 2017 13:58:54 +0000 littlejoy 2732379@https://boards.hellobee.com/ <p>I am fighting with my insurance to approve my lactation consultant services, and would love a little advice. </p> <p>Per the ACA (which is obviously going to change), insurance providers cover lactation care. </p> <p>My insurance company is unable to provide me with a list of providers or services (which I find laughable), but they say they cover care from a "licensed provider". I visited a IBCLC with the gold-standard of certification - she's literally the best in the city, and my insurance is saying they only cover care given by an MD or pediatrician (neither of which are equipped to guide this kind of care). </p> <p>The bill is only $100, but still - I'm gearing up to deliver the baby soon, and know I will need to see this LC again (I had major lactation failure last time due to numerous physical issues with LO and myself). </p> <p>I've pushed this issue with the insurance company, and now they want to get on the phone to discuss. I feel like everything should be in writing (I was previously told the services would be covered at 50%). </p> <p>FWIW, we are having a homebirth with a CNM group (so, not able to see the hospital lactation consultants), and our family doctor and midwives always refer all breastfeeding issues to a licensed LC. </p> <p>Have any of you gone through this? I feel like the services should be covered, as it's basic lactation care with a licensed provider. I'm not sure how hard to push. </p>