Insurance?

When most people call their insurance company inquiring about coverage for a lactation consultation, they’re often told that no coverage exists. Many times this is not accurate. The insurance personnel are simply less familiar with coverage for lactation services because my profession is in its infancy and still highly unknown. Most lactation colleagues do not hire a billing person, so the claims don’t get covered because they’re not submitted in the first place, or the coding is not completed properly. Lactation consultations are conducted for various medical necessities such as slow weight gain, infant feeding problems, and low milk supply issues. Lactation consultations are not done only for educational purposes.  However, often times the insurance agencies assume this and tell customers that coverage is not available as a result.

Why is there a fee? There is a fee for my services like other fees you encounter such as the doctor’s visit, the hair dresser, the cleaners, the dentist. Fees for service keep me in business by subsidizing my lease for my office, my supplies, my leasing fees for breastpumps, my office/paperwork supplies, my professional liability insurance expenses, and my ongoing professional education to maintain my level of expertise. Thank you for your business!  It keeps me in my practice, so I can continue to offer effective interventions to others for managing the “therapy” necessary to achieve breastfeeding.

When conducting a lactation consultation, I assess your latch, measure the volume of intake at the breast, provide interventions for the identified problem(s), and develop a plan of care to achieve your breastfeeding goals in the most effective, simple way. I believe in identifying the root cause of the problem(s) and streamlining the interventions to target your source of frustration, and then carve a path directly to your needs.  For instance, if experiencing a low milk supply, it will be identified by measuring accurately and not just presumed or guessed because this kind of sloppy care can miss the actual cause of your problem(s) and thus not correct them.

CPT codes are the language used by the health care insurance industry to describe types of reimbursement. CPT code #99205 is used for a consultation in my office and CPT code #99344 is used for a consultation in your home. Office visits are often covered as outpatient services whether conducted at a hospital or in my office. The amount of coverage is the same. Some health plans will reimburse for an RN home visit and not a lactation outpatient visit. The diversity of plans available does make it confusing, and therefore I cannot know for sure how much coverage is available for every plan.

Breastpump rentals are less likely to be covered by insurance plans than the pump tubings and lactation consultations.  The reason for this blip in the system is because most of the time breastpump rental services do not pay the fees and conduct the paperwork for being a DME (durable medical equipment) provider. Why? Because DMEs are typically for people ages 65 and older. Not many 65’ers need breastpumps; thus it is not worth the requirements to pursue a DME.  But, the best way to seek reimbursement for your pump rental costs is to provide you with a receipt for your pump rental fees and have you submit it yourself.  This is the most effective way to get reimbursement.  When making your breastpump purchase, you can apply it to your flex spending account when you make your purchase with me, since I provide the proper form for submission.