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Episode 47 Lori talks Insurance.
LACTATION CONSULTANTS & INSURANCE REIMBURSEMENT.
After spending the last few years in the world of Insurance Reimbursement for Lactation Services, I have updated the information on my website about this topic. It had me thinking about my strong feelings related to this whole topic and I decided to get more personal and write about it and that led to me wanting to do a show about it. When it comes to Healthcare in the United States as it relates to lactation services, it is pretty piss poor. This is a hot topic and one that I have to respond to on a daily basis to moms that call up for breastfeeding help. With the Affordable Care Act, and with what Insurance companies are claiming, the expectation is that they can get help from lactation consultants like myself and rent hospital grade pumps like I rent and not have to pay out of pocket for these services or products. Based on what parents are told, I can easily understand why they might think this. However, there is what parents are told & then there is the truth of the situation. Here is the letter I have written that you will see when you come upon my website – aabreastfeeding.com or allaboutbreastfeeding.biz
As a working woman and mother of 3, I know the financial burden having a new baby can be on the families budget. You may have come upon this page because you are looking to hire me as your lactation consultant. Since you have heard that insurance companies are covering lactation services, but perhaps cannot get the answers you need from your insurance company, you have come to this website to try and find out if you can make an appointment with me for lactation help and not have to pay out of pocket.
If you are like most mothers who have insurance coverage, you more than likely expected to be given a list of names (IBCLCs in your area) that you could make an appointment with for lactation help. You quickly find out that your insurance company tells you that while they will cover lactation services, they do not have names of any IBCLCs providing this service. This is confusing to you. They say they will cover it ( although no one guarantees) but they don’t have a list of anyone you can see. If you called up to find the names and numbers of pediatricians, you would be given a list of names and numbers of providers in your area. But this does not happen with IBCLCs.
This is because your insurance company has not contracted with any private practice IBCLC to be in their network. We cannot be a provider for them as they will not accept us in their network. In the state of Arizona, there were over 85,000 births in 2014. In the state of Arizona, there are between 275 and 300 IBCLCs. And yet, less than perhaps 5 or 10 have been accepted into the insurance programs as a provider. In the whole state of Arizona. Where 85,000 mothers gave birth in 2014. This is exactly why you are getting the run around from your insurance company.
I recently applied to a major insurance provider and was denied being a provider as they stated this area was saturated with providers. What??? A handful of IBCLCs have been accepted as providers and the area is saturated? What??? I have applied to other insurance companies and am turned down because they are not offering provider status to IBCLCs. I have been a breastfeeding educator for over 25 years and an IBCLC since 2001 and yet I am denied the ability to become a provider for the insurance companies. Not just me, of course, but my peers also. This is insane.
So here is what I would tell you. If you have questions about breastfeeding – set up a consult and have your concerns and questions answered. If you are having problems with breastfeeding and they are keeping you from enjoying breastfeeding, set up a consult.
Hire me as your lactation consultant. Get the experienced and compassionate help you need, you deserve and you desire. Go home with a paid bill that you can turn into insurance for reimbursement. Breastfeed your baby in comfort and joy. Do not let the insurance companies dictate how you feed your baby. Feeding your baby is not an option. We all know that you are going to feed your baby some food, one way or the other. How and what you feed your baby should be your choice, not your insurance companies.
Earlier I stated statistics about how many births in AZ there were and how many IBCLCs in AZ there are. I am a person who hates numbers and hates statistics. I do admit though, that they do have their place. So, I will mention just a few more because as we get deeper into the statistics, the insanity continues. Taken from the CDC.gov website, in 2014, 81% of new mothers started off their babies new life breastfeeding. By 6 months of age, only 18% of the babies were exclusively breastfeeding. The research has shown, hands down, that the reason most mothers do not continue breastfeeding as long as they had initially desired is because they did not have access to good lactation care in the early days of breastfeeding.
Is this a rant? Yes, it is! I am ranting about this for all the moms and babies who are denied good lactation care. I am also ranting about this because I want you to NOT let the lack of coverage dictate how and what you feed your babies. Do NOT allow the insurance companies to dictate how you feed your babies.
Hear me out….
As a first time mother, newly postpartum with my first baby, I suffered horribly with painful breastfeeding. My nipples were cracked and bleeding. Breastfeeding hurt me, before, during and after each breastfeeding. I reached out for help, but there was none available. The closest I was able to find help from were LLL who were volunteers. Every time I called and was crying, I kept being told the same thing… it is normal for breastfeeding to hurt in the beginning, but just keep going and it will get better, AND BTW, be sure to come to our monthly meeting. Breastfeeding was incredibly painful and it took away some of the joy in the early days of new mothering because I would look at my baby when she cried to eat…. and I would start crying too. When Alisha latched on, I would clench my jaws and tremble in pain. And if noone was there, I would let the tears roll down my face and if someone else was in the room, I would do by best to hide my tears. When she was feeding, I would look at the clock and decide when she was done, rather then just let her decide when she was done. I didn’t know it then, but I do now… Breastfeeding is not supposed to hurt and when it does, it is a sign that something is not quite right. I also didn’t know then that cutting her from having a full feeding, created havoc with my milk supply. There were no IBCLCs at that time and noone who would meet with me to help me out. Somehow I muddled through it all, however, I know for sure if I had access to a lactation specialist, I would have jumped at the chance. If I could not afford it, I would have asked my mother for a loan. I would have asked someone else for a loan if need be.
In the early years of IBCLC, no insurance companies paid for it and it was all out of pocket. Mothers were decided if their breastfeeding situation warranted paying an expert for help. Now I find that many mothers are deciding if they should get help solely based on if their insurance company will pay for it. Do, you see what I am saying?
As a lactation consultant, I know the emotional hardship that a new mother endures when breastfeeding challenges are creating problems with milk supply, babies weight gain and pain during breastfeeding. My greatest wish is that you are able to see beyond the immediate financial aspect of your care & do whatever you can to get the help you need so you can get to a place of breastfeeding your baby in comfort and joy. Every mother and baby deserves the very best care.
If your insurance company does not fully cover your lactation consult for you ahead of time, they will more than likely reimburse you once you send in your paid bill.If they deny you, please use the form I am including in the show notes so you can appeal the denial. If finances are really tight, don’t be shy. A close family or friend will likely be very happy to loan you the money so you can get help. Most are okay to wait a little bit for you to pay back and others are glad to gift it to you. If your insurance company DOES fully cover you, but you cannot get in to see an IBCLC in network for many days, consider the situation that you are in and decide if you can wait. If you can find an IBCLC that you can get in sooner to see & she is out of network, pay ahead and get reimbursed later. You will be glad you did.
Of course, I am standing up and being strong for myself and I am fighting for my profession. I know that you would do the same for something or someone that you believed in and cared for. I believe and care for breastfeeding mothers and I am fighting to make common sense out of this whole insurance debacle so mothers will get the help they need.
Over the years, I have met my fair share of moms who were not able to continue to breastfeed their first baby because they held off getting help. They have told me that they either just kept hoping it would get better on their own, or they were upset that their insurance company did not cover lactation services. They felt that they were already paying so much for their insurance plan, they were going to be darned if they were going to pay for this service out of pocket.
Some mothers had a choice to wait a week to get help or to see someone quicker, but have to pay out of pocket first and get reimbursed later. Ask any mom who has been in this situation, and she will tell you that she wishes she would have had help as soon as possible. When the breastfeeding was lost, they were upset, angry and some mothers became depressed. The reality is, that it is not a question of feeding your baby. Are you going to feed your baby or not? Of course you are going to feed your baby. And whether you spend money of things breastfeeding related or formula related, you are going to spend money feeding your baby. So, why not get to make the choice yourself and decide how you want to spend your money. Mothers realized after the fact that they did wind up spending money on feeding their baby. Their insurance company was not paying for the years worth of formula. That came out of their pocket. In hindsight, mothers realize that one way or another, you do have to spend money to feed your baby. If the insurance companies are not helpful, that totally sucks. No really, it does. It really does suck.
What’s worse though is that parents are allowing the insurance companies dictate how they get to feed their babies. In other words, if they won’t pay for lactation services, then parents can elect to pay for help out of pocket, or not. For the moms that get through their challenges, it is a shame that they had to suffer while waiting for breastfeeding to get better. For the moms who were not able to help themselves and they discontinued breastfeeding and switched to formula, or switched to pumping and bottlefeeding, this is what I mean when I say the insurance company dictated how you fed your baby.
You see, feeding your baby is not an option. Period. You love your baby. You will feed your baby. Your baby will grow and your baby will gain weight. You will spend money on feeding your baby. Whether it be on breastfeeding help and nursing bras and breastpumps, or perhaps it will be on formula. My point is, parents should get to choose. Not let the insurance companies choose for you.
When you are suffering with breastfeeding challenges and you are waiting on your insurance company to decide, you may wait too long and the breastfeeding will be lost. Your supply may have suffered. Your baby may have lost too much weight. You may have become so anxious about ensuring your baby gets enough that now bottles and formula or bottles and your milk seem like an easier route to go. You may have been in far too much pain and needed relief and could not continue breastfeeding.
I would like to add here that it is of utmost importance to your breastfeeding relationship that you seek professional help immediately and see an IBCLC as soon as you realize you are having breastfeeding concerns. As a new breastfeeding mom, it would be normal for you to feel overwhelmed and sleep deprived and have many questions as you learn the art and science of breastfeeding. It is not normal for you to struggle everyday with the basics of breastfeeding – there should be no pain, you should have a fairly easy time of getting your baby to latch on and your baby should be quite satisfied after most breastfeeding and gain the appropriate amount of weight each week. While it would be nice to have my services covered and you not have to pay anything out of pocket, this sometimes is not able to happen. However, most insurance companies will easily accept your paid bill and reimburse you for your lactation consult. If you are turned down, there is a process that you can follow to do your absolute best in getting your reimbursement. Sometimes we just have to work hard for what we want. I am including several links that I have mentioned in this show.
I do get to hear feedback from my clients and a majority are now getting reimbursed for my services. I would love to hear what your experience has been.
Feel free to go to allaboutbreastfeeding.biz/contact and send me your story. You can also go to the same website: allaboutbreastfeeding.biz and follow the link on the right-hand side of your screen that says voicemail. Click it on and you can leave me a voicemail.
Links: For more information about Lori’s Virtual Breastfeeding Mother’s Group –
For more information to Lori’s Skype
Links related to Insurance Reimbursement:
1. Chimicles & Tikellis LLP is investigating a potential class action lawsuit on behalf of women with individual health insurance or employer-sponsored coverage that were either denied coverage for mandatory breastfeeding support, supplies or counseling or were required to pay, out-of-pocket, a portion of such costs.
2. National Women’s Law Center – Explains the law and gives sample letters for how you can appeal if you have been turned down. Tool Kit
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