If you have Anthem through Google, you will receive 100% reimbursement for lactation services provided in your home by an IBCLC. You pay at the time of visit, receive a superbill, and you upload that superbill to Anthem to request your reimbursement.
If you have Anthem NOT through Google, there is a lengthy process you must undertake prior to a visit if you want to increase your chances of receiving reimbursement.
As far as I can tell, UnitedHealthcare and Cigna will only pay for lactation services received at a medical facility such as a pediatrician office or hospital network.
I am not in-network with any insurance company.
Please call your insurance company prior to scheduling a visit to find out if they cover home visit and telehealth lactation care, at what rates, and what billing codes, as these details vary with each company and change frequently.
REAL TALK ABOUT INSURANCE COVERAGE:
With any insurance that is not Google's Anthem plan, people typically experience significant and frequently insurmountable challenges obtaining any reimbursement for in-home lactation care.
SHOULD it be covered? YES.
WILL it be covered? NO, almost certainly not.
Why?
Because it is not in the interest of insurance company shareholders for insurance companies to cover anything if they can get away with not covering it. If enough people made enough trouble for insurance companies, that might change. However, families in need of lactation support rarely have the time and energy required for that fight.
SOMEWHAT MORE POLITE TALK ABOUT INSURANCE COVERAGE:
Under the Affordable Care Act, lactation counseling is supposed to be covered without cost-sharing as a preventive women’s health service under almost all insurance plans.
Unfortunately, the reality is often very different than the letter and intent of the law, and reimbursement for lactation consultation can be difficult to obtain.
Each insurance plan has its own approach to lactation coverage. Some have an in-network provider list, others expect people to receive lactation care only in hospital settings, and others reimburse more readily for in-home lactation care. Call your insurance company and review your plan details. I cannot do that for you.
At our visit, you pay me directly and I will provide you with a superbill. You then take the process from there and submit the superbill to your insurance plan to request reimbursement, accompanied by any specific additional forms your insurance company requires.
Here are a few resources to guide you as you navigate the reimbursement process with your insurance company:
Benefits for Breastfeeding Moms, Understanding Health Coverage of Breastfeeding Support and Supplies, from the National Women's Law Center
National Women's Law Center Breastfeeding Toolkit
New Benefits for Breastfeeding Moms: Facts and Tools to Understand Your Coverage under the Health Care Law
Sample Letter for Coverage of Lactation Care, excerpted from the NWLC Toolkit linked above.
To be used if your insurance company has denied reimbursement for your claim.
Alternatively, you can use HSA, FSA, HRA accounts to pay for lactation care.
Unfortunately, I cannot guarantee that your insurance plan will fulfill its obligations and appropriately reimburse you. Chances are high that they will not.
If you need additional support through this process after an insurance denial, you may file a complaint with the California Department of Managed Healthcare here.