SALT LAKE CITY — A baby is on the way and you’ve got so many things buzzing through your mind; things like setting up a nursery with all the necessities, which car seat you should get and what is the best stroller.
One thing you're probably wondering about is whether a lactation consultant and lactation support are covered by your health insurance — which is exactly what this article is all about. Let’s get straight to the point.
But first ... a little history
Back in 2010, the Affordable Care Act passed two laws that applied to breastfeeding mothers. The first was in relation to work: Employers are now expected to provide a break and a private area for women to pump during work hours. The second law is that insurers are now required to cover breastfeeding support services and any breastfeeding equipment.
With the rise of working mothers and more conversation around "the fifth trimester" — which author Lauren Smith Brody defines as the period of time “when the working mom is born” — these were two laws that many believe needed to be passed. However, having a space to pump and breastfeeding supply coverage are only two items on the lactation spectrum.
So, when it comes to health insurance coverage for lactation support services, what exactly do mothers get coverage for? In general, these three types of services are covered:
- Prenatal breastfeeding support and counseling provided by a professional
- Postnatal breastfeeding support and counseling provided by a professional (this support is covered during the entirety of the breastfeeding period)
- Breastfeeding equipment (ie. a breast pump) that is either rented or purchased
As with most things, these overarching categories come with a sprinkling of caveats. So, here’s what you should know:
Talk to your insurance
The coverage you receive for lactation support — both prenatal and postnatal —heavily depends on your insurance company, the specific plan you have through said company, and the type of lactation support service you need.
You can Google questions until your fingers turn blue, but the best way to learn about your lactation support coverage is by directly talking to your insurance about your benefits. Websites and articles may have information that is no longer up to date or applicable, so speaking with someone who can give you a straight answer is the best way to get information about what services will be covered through your insurance plan, along with how much coverage you’ll be receiving.
You can Google questions until your fingers turn blue, but the best way to learn about your lactation support coverage is by directly talking to your insurance about your benefits.
When you talk to your insurance, ask about:
- Lactation consultants: If you are delivering at a hospital and your insurance is covering your hospital stay, you may be covered for a lactation consultant during your stay. Coverage for lactation consultants working in conjunction with your doctor, your baby’s doctor, or a private practice varies depending on your insurance company. Some insurance companies may be more likely to cover the fees of a lactation consultant who is also a nurse practitioner, physician or midwife, so be sure to clarify any details. You may be required to co-pay if you are requesting lactation consultant services at home or in a doctor’s office. Coverage may also vary depending on if your healthcare provider and/or lactation consultant is within your network of providers.
- Breast pump coverage: Your specific insurance plan may have rules about the type of breast pump it covers (manual or electric), how long they will cover the duration of the rental period, and when you will receive the pump (prenatal or postnatal).
- Doctor authorization: Some health insurance companies will provide a varying amount of coverage depending on the authorization and recommendation of your healthcare provider. Speak with your doctor about your options and what type of support services they have available to you.
The 'milky' bottom line
Lactation support can be covered by your health insurance, but what type of services and how much coverage you receive depends on your insurance company. Talk with your insurance about your options for coverage and speak with your healthcare provider to see what he or she recommends is best for you and your birth plan.
Brooke Nally is native to Utah but likes to see other parts of the world as often as she can. You can contact her via email: firstname.lastname@example.org.