Insurance Coverage and Reimbursement

I am in network with Aetna and can bill directly for clients with qualifying plans. Please note it's the client's responsibility to verify coverage for lactation care, and to notify the IBCLC about any changes in coverage. Client is responsible for any amount not covered by insurance, which will be listed on your EOB; the credit card on file will be charged in this case.

For clients with other health insurance plans, you would pay upfront for your visit, then I will provide you with a superbill that you can submit to your insurer for reimbursement.

The Affordable Care Act of 2010 requires that lactation care and support services (including breast pumps) be fully covered by non-grandfathered insurance plans. But every insurance company has their own policies about how they cover lactation services.

So all this is to say, while it’s your right to have your costs for lactation care reimbursed by your insurance company, it may not be a simple process. 

Fortunately, many of the major private insurers in Massachusetts are reliable about reimbursing in this way for lactation visits.

If you submit and are denied, I’m happy to provide additional info your insurer may be requiring so you can submit again. Unfortunately I can’t guarantee that your visit will be fully reimbursed as it depends on the specifics of your plan.

Before booking a visit please contact your insurer to confirm coverage, to determine the process for reimbursement, and to obtain pre-authorization for services if necessary.

Here are some resources with some really helpful information on insurance coverage and the reimbursement process:

How to get reimbursed for an IBCLC home visit by Rachel O’Brien, IBCLC

Breastfeeding Benefits: understanding your coverage under the Affordable Care Act from the National Women’s Law Center