Dana/Westchester Lactation is an out-of-network provider with all 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 (ie. those few employer-sponsored plans that existed before March 23, 2010, and have not made significant changes), all insurance companies should be covering the cost of breastfeeding support, supplies, and counseling (including comprehensive prenatal and postnatal lactation support and counseling), without any cost-sharing.
How do I know what my plan covers?
You can 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 it is, your options may be limited. But keep in mind that only a very small number of plans fall into this category. If not, remind them that the healthcare law requires that they provide this benefit.
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 firstname.lastname@example.org
If you purchase your plan on your own or through the marketplace, contact your state insurance commissioner:
Can I be reimbursed if my insurance requires that I see an in-network provider only?
Maybe. Only a few plans actually have or require that lactation consultants to 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 to process the request:
Lactation Consultant Name & Certification: Dana Hilsenrath, IBCLC
Mailing Address: 104 Highridge Rd, New Rochelle, NY 10804
Please feel free to contact me if they require any additional information to process your request.
I still need help navigating this issue. Any advice?
The National Women’s Law Center is a great resource for understanding and asserting your right to comprehensive lactation support coverage. They have a wonderful toolkit which, in addition to detailed information surrounding the issue, provides phone scripts, email templates, and more. It can be found by clicking the following link: https://nwlc.org/resources/new-benefits-breastfeeding-moms-facts-and-tools-understand-your-coverage-under-health-care-law/