Will my health insurance cover this visit?


For insurance plans, I am considered an “out-of-network” lactation consultant. “Out-of-network” providers are not typically fully covered by your health plan so you are often responsible for greater cost-sharing or even the entire cost of the visit. You can contact your insurance company to verify your benefit coverage and cost-sharing for an out-of-network lactation consultant. If your insurance company and policy are required to follow the ACA guidelines and they don’t have any lactation consultants in-network, they generally must cover services from an out-of-network provider without cost-sharing. This is sometimes referred to as “gap coverage.”

If you have a Health Saving Account (HSA) or Flexible Spending Account (FSA), lactation consultation services should be considered a qualified medical expense. Clients can pay with an HSA/FSA credit card.

I provide all out-of-network clients with a “superbill” or detailed receipt which you may submit to your insurance for reimbursement. Travels fees are not included and will be on a separate receipt.

For more information, the National Women’s Law Center has a very helpful toolkit and a Sample Letter for Lactation Consultant Coverage that can be downloaded and used to support your efforts for coverage.

Helpful links and forms:

Sample coverage letter for Lactation Consultant Coverage

Patient Instructions for filing reimbursement

Affordable Care Act

Tricare Breastfeeding Counseling Policy

Tricare Breast Pump an Supplies Policy

Blue Shield California Preventative Care Coverage

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