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23 | Making Sense of Insurance Coverage for Lactation Care – Lactation Business Coaching with Annie and Leah
You are going to provide your services to the families who need it, even if it means a headache when it comes to the paperwork and receiving a fair fee from insurance companies. The Affordable Care Act did some good in stating that lactation services would be covered, but because of the vagueness of the phrasing, there is no clear consensus among insurance companies and providers about what this should look like in reality. Annie and Leah provide some tips for listeners who want some help navigating this topic in order to focus on serving their families better.
- The Affordable Care Act says that “lactation services are covered” but doesn’t specify who the providers should be, what the timing should be, or who should determine if the services are needed
- Insurance companies only want to cover the lactation consulting services at the hospital immediately after birth and at the pediatrician’s office, so they are quick to deny coverage for anything outside of those instances
- The National Women’s Law Center, however, provides scripts for families to use when talking with their insurance companies to ensure coverage of lactation consulting services
- Typically, the consultant handles in-network insurance claims and agrees to the insurance company’s prices for their services and the consultant provides a superbill to clients who are out-of-network for the client to submit to their insurance company
- The providers feel obligated to provide services to clients regardless of their insurance status because it is a right
- Sometimes out-of-network insurance companies will call or write to argue with your billing amounts
- It is unclear whether it is more successful for the provider or the client to submit the superbill to an out-of-network insurance company
- Leah talks about the benefit of looking at your average payout versus your per-consult payout to assess how your business is working with insurance and self-paid clients
- Annie recommends the diagnosis code of Z39.2 and the procedure code of either S9443 or S99404 because these are the most conservative and hardest for the companies to argue with
- It is important to ethically bill your clients and seek information from a variety of sources
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- “Everybody needs help.”
- “If you’re paying up front for lactation services, you’re not paying down the road for these health outcomes that could have been prevented if breastfeeding was successful or had lasted longer.”
- “Their [the insurance companies’] business model is the problem.”
Leah Jolly is a private practice IBCLC with Bay Area Breastfeeding in Houston, Texas. Annie Frisbie is a private practice IBCLC serving Queens and Brooklyn in New York City, and the creator of Paperless Lactation.
The Lactation Business Coaching podcast is produced by us and edited by Jillian Grover, who also writes our show notes. Our theme song is by Silas Wade.