Insurance Coverage for Lactation Services
Insurance coverage for breastfeeding services is by no means a universally covered benefit in Rhode Island. As coverage varies widely between health care insurers , it is always best to contact your insurance provider directly prior to receiving any services. Sometimes, if insurance will pay for a covered lactation benefit, your insurer will want you to use a preferred provider. Your insurer can provide the name and number of the health care professional or medical equipment company they require you to use. By using that preferred professional, the insurance company will be able to be billed directly; hopefully without any out-of-pocket expense.
Most insurance companies do not cover in-home consultations. There are three companies who are paying for our services:
- Tufts will reimburse mothers $75 for each consults with us, up to 3 consults.
- We are able to bill United Healthcare for our services for Rhode Island State Employees who have the state plan. Rates of reimbursement vary depending on your deductible etc. Please contact United directly regarding your coverage.
- Harvard Pilgrim will reimburse mothers who have received IBCLC services up to 6 weeks post-partum. There is no limit to the number of consultations and both office and home consults are reimbursed at different rates.
At this time, Healthy Babies, Happy Moms has a contract to provide breast pumps only with BCBSRI. We are a provider of double electric hospital grade breast pumps for medical necessity and manual pumps. As there are wide variations in plans, please contact your customer service representative to verify coverage and benefits and obtain a prescription from your physician. We can then provide you with a pump and bill BCBSRI!
There are many requirements to gain provider status, and we are working diligently to fulfill them and obtain contracts with all local insures. It is our hope to have that finalized in 2013. In the meantime, mothers who need our services pay for them upfront. Sometimes, you can be reimbursed for lactation costs after you have paid HBHM Inc. We are happy to provide you with whatever documentation you may need for reimbursement from your insurer.
If you have a Flexible Spending Account for Health Care, they typically reimburse you for our consults and for breast pump rentals and purchases. As of November 2011, we have been verified by our credit card processing service as a company providing healthcare services and products. This means you can now use your healthcare flexible spending card to pay for our services and products!
In addition, there are many organizations working at the state and national level to help foster policies that support insurance coverage for breastfeeding services. The more mothers that call their insurers and ask for this type of coverage, the more insurers will acknowledge both the demand and the long term cost savings and public health benefit generated by an increase in breastfeeding initiation and duration rates. Please make the call to your insurer before you have your baby and let them know this is important to you and your family!