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: