What Does My Insurance Cover?
“Just Natural” feels very strongly that effective Lactation Services should be covered by insurance just like any other health care situation. Breastfeeding is at the very core of preventative care. The Affordable Health Care Act states lactation services will be covered by insurance. (See woman’s law center link below ) Most insurance companies state they cover lactation services, however, most insurance companies do not allow Lactation Consultants In-Network. In Southern California, only Aetna allows lactation consultants in network. We are in net-work with Aetna, and there will be no out of pocket cost for you other than a copay, co-insurance, or a courtesy fee for home visits. For PPO insurance, We can provide a Super Bill that you can submit to your insurance company for reimbursement. You can use your health care spending account to pay for lactation services. I recommend you check with your insurance company to inquire about your coverage. In some cases the insurance company can give give you a referral to an IBCLC in network or that can bill your insurance in your area. If they refer you to a free clinic with limited resources and availability then they are not full filling their obligation under the Affordable Care Act. The pricing for our services listed, is a prompt pay discount. This means the prices reflect a significant discount if services are paid for at the time of booking the appointment. Otherwise our prices resemble what would be billed to an insurance company.
“Gap Exception” Since the affordable care act requires insurance companies to provide lactation services, but does not have an IBCLC in net-work, you can call and ask for a exception for the IBCLC you choose. This IBCLC needs to have a Tax ID # and an NPI #. You will need to call for approval your insurance company 30 to 45 days in advance for approval. This is a great option for any mom who is proactive and looking for her own lactation consultant prior to the baby’s birth. “Just Natural” meets the qualifications to bill insurance and is willing to help you with this process.
Insurances we work with:
- In-network with Aetna
- Can Provide Super Bill for reimbursement to PPO insurance
- May be able to bill HMO with a gap exception
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