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Under the Affordable Care Act, most insurance plans are required to cover comprehensive lactation support by a trained provider, even if out of network. There are some grandfathered in plans and Medicaid/Medicare exceptions. Please refer to your specific plan for details. Lactation support is eligible for most FSA/HSA plans. Provided with your consultation is a receipt, otherwise known as a superbill. This is the documentation you will use to submit to your insurance company for reimbursement. No healthcare provider can tell you what your insurance will cover so you are encouraged to contact your insurance company directly to find out what type of lactation/breast/chestfeeding support they will cover. The two best questions to ask of your insurance company are:
What are my lactation benefits?
What are my Out of Network Benefits?
Often insurance companies will insist that you see a provider in network. If that is the case, ask them for the list of providers available in your area that you can see. If they can not provide one to you, consider appealing your claim based on required coverage under the Affordable Care Act.
The National Women's Law Center has created a detailed toolkit you can download at the following link to help guide you through the insurance reimbursement process. Know your rights. Know your benefits.
You can read more about it here:
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