Insurance
I am in-network with Aetna. If you have insurance through Aetna, I will submit claims directly to them on your behalf. Aetna typically covers 6 in person visits. Please confirm your own benefits in case your plan has any exceptions (for example, self-insured employer plans may offer different coverage).
I am an out-of-network provider with all other insurance plans. If you are not with Aetna, you will pay the fee directly to me, and I will provide you with a coded superbill receipt, which you can submit to your insurance company for reimbursement. It is a good idea to call your company to see what kind of lactation coverage you have and/or to request pre-authorization to see an out-of-network provider.
What is my insurance company require to cover?
Under the Affordable Care Act, many insurance companies are required to cover preventative lactation services without any additional costs or copays. According to Healthcare.gov, “Health insurance plans must provide breastfeeding support, counseling, and equipment for the duration of breastfeeding. These services may be provided before and after birth.”
The National Women’s Law Center’s Breastfeeding Toolkit is a wonderful resource for determining whether your plan is required to cover lactation support, and how to respond if they are required but don't offer coverage. The kit also includes helpful language for how to call your insurance company and demand services, including a sample script!
How can I find out what my plan covers?
Call the phone number on the back of your insurance card to find out what kind of lactation coverage your plan offers. If the first person you speak with does not know or says that your plan does not provide lactation coverage, ask to speak to a supervisor and ask if your plan is “grandfathered.” If it is, your options may be limited. If it isn't, let them know the ACA requires that they provide this benefit. The NWLC toolkit also includes instructions on filing an appeal if your claim is denied.
What if they tell me I can only see an in-network provider?
If your insurance provider tells you they only cover in-network providers, you can ask for a "Geographic Gap Exception," This is a tool health insurance companies use to address gaps in their network of contracted healthcare providers. You are entitled to ask for your insurer to cover care you get from an out-of-network provider at the in-network rate. If they require any additional information about me to approve an exemption, please contact me at [email protected] or 914-861-5228.
I am an out-of-network provider with all other insurance plans. If you are not with Aetna, you will pay the fee directly to me, and I will provide you with a coded superbill receipt, which you can submit to your insurance company for reimbursement. It is a good idea to call your company to see what kind of lactation coverage you have and/or to request pre-authorization to see an out-of-network provider.
What is my insurance company require to cover?
Under the Affordable Care Act, many insurance companies are required to cover preventative lactation services without any additional costs or copays. According to Healthcare.gov, “Health insurance plans must provide breastfeeding support, counseling, and equipment for the duration of breastfeeding. These services may be provided before and after birth.”
The National Women’s Law Center’s Breastfeeding Toolkit is a wonderful resource for determining whether your plan is required to cover lactation support, and how to respond if they are required but don't offer coverage. The kit also includes helpful language for how to call your insurance company and demand services, including a sample script!
How can I find out what my plan covers?
Call the phone number on the back of your insurance card to find out what kind of lactation coverage your plan offers. If the first person you speak with does not know or says that your plan does not provide lactation coverage, ask to speak to a supervisor and ask if your plan is “grandfathered.” If it is, your options may be limited. If it isn't, let them know the ACA requires that they provide this benefit. The NWLC toolkit also includes instructions on filing an appeal if your claim is denied.
What if they tell me I can only see an in-network provider?
If your insurance provider tells you they only cover in-network providers, you can ask for a "Geographic Gap Exception," This is a tool health insurance companies use to address gaps in their network of contracted healthcare providers. You are entitled to ask for your insurer to cover care you get from an out-of-network provider at the in-network rate. If they require any additional information about me to approve an exemption, please contact me at [email protected] or 914-861-5228.
