We've all heard (I hope) that lactation services and breastfeeding supplies will now be "covered by insurance."
What does that exactly mean? Therein lies the rub: it depends on your insurance.
First, it has to be a plan that started on or after August 1, 2012. Second, your plan has to be affected by the Patient Protection and Affordable Health Act. I’ve read that if your plan has to comply with the legislation, then no co-pay or co-insurance should be charged to you for all "breastfeeding support, counseling and supplies.” However, "Your insurance provider is your source to confirm if your plan is affected." So… we are all supposed to make that super awesome 1-800 call to our insurance company to find out. I especially love when they ask you to enter an alpha-numeric number into your keypad….
Well, I just got off the phone with Customer Support for my Anthem Blue Cross Lumenos HSA plan. This was the gist:
What is covered: Breast pumps - 80% of cost after deductible*. This is under the “Durable medical equipment benefits” category.
What isn’t covered: Everything else. Breastfeeding classes, lactation consultant appointments, and any equipment that does not have a procedural code is not covered. (These codes are basically a series of telephone books with a letter-number combo for everything deemed reimbursable by Medicaid and consequently the insurance companies.) It is pretty difficult to bill anything to insurance without one of these codes.
Shocked Me: “Does this comply with the Patient Protection and Affordable Health Act?"
Agent: “Yes, and it was part of your benefits even before the legislation.”
These agents don't have a degree in medical coding and neither do I, but I did some digging, and there is actually a code for breastfeeding counseling, but it seems to not cover LCs (at least not yet). Anyone out there know? Anyone? One code seemed interesting under breastfeeding counseling according to this site: “Education and training for patient self-management by a qualified, non-physician health care professional using a standardized curriculum: 98960.”
According to another site: there is also a code for “Misc medical supplies for breastfeeding management and support” which includes nipple shields and creams that are prescribed by a doctor, mid-level, or midwife. These codes are: CPT: A9900 Modifier: NU ICD-9: V24.1. I intend to bill all my supplies in a claim form using this code. I’ll let you know what happens. With my first child, I spent about $500 to get past that initial breastfeeding learning curve. This time, let's hope everything I need to make breastfeeding happen is covered, including the breastfeeding pain relief provided by TendHer Pillows!
* The agent later called me back with the correction that breast pumps are covered at 100%, as long as the provider has a contract with Blue Cross.
For more information, especially in regards to IBCLC reimbursement, go to: