Insurance

Out-of-Network: All Other Plans

Dana / Westchester Lactation is an out-of-network provider with all other insurance plans. Following your appointment, you will receive a Superbill which you can submit to your insurance company for reimbursement. It is a good idea to call your company to see what kind of lactation coverage you have and/or to request pre-authorization to see an out-of-network provider.

Does All Insurance Cover Lactation Services?

Not all insurance plans cover lactation services, but most do. Under the ACA, health insurance plans are required to provide "comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum period, and costs for renting breastfeeding equipment" for each birth. With the exception of grandfathered plans, all insurance companies should be covering the cost of breastfeeding support, supplies, and counseling without any cost-sharing.

How Do I Know What My Plan Covers?

Call the phone number on the back of your insurance card to find out what kind of lactation coverage your plan provides. If the first person you speak with does not know or says that your plan does not provide lactation coverage, you may need to dig deeper. Ask to speak to a supervisor and ask if your plan is "grandfathered."

If you are still not getting the correct answer, you have several options:

• File an internal appeal (you can find sample letters in the National Women's Law Center (NWLC) Toolkit.
• Contact the NWLC at [email protected]
• Contact your state insurance commissioner: New York · New Jersey · Connecticut

Can I Be Reimbursed If My Plan Requires In-Network Only?

Maybe. Only a few plans actually require that lactation consultants be in-network providers for reimbursement. If yours is one, you can ask for an exception due to limited appointment availability with in-network providers, or due to lack of in-network options in your immediate geographic area. They may require the following information:

Still Need Help?

The National Women's Law Center is a great resource for understanding and asserting your right to comprehensive lactation support coverage. Their toolkit includes phone scripts, email templates, and more: NWLC Breastfeeding Coverage Toolkit