Getting Insurance Reimbursement
- In most instances, you will be asked to pay the provider of breastfeeding services directly at the time the service is given. It is the patient's responsibility to file for insurance benefits.
- Not all insurance providers reimburse for breastfeeding services. They are more likely to do so if there is a medical need on the part of the mother or infant. A doctor's prescription for the service is advisable.
- MediCal and CPSP (Comprehensive Perinatal Services Program) provide lactation support through their certified providers where there is medical need. This is usually done through, or supervised by, a licensed health practitioner.
- If the medical need is for the infant (hospitalized, allergic or premature), apply for payment on the baby's insurance claim. If the medical need is for the mother (hospitalized, breast infection), apply for payment on the mother's insurance claim.
- A mother returning to work and pumping her milk is not usually considered medical need.
- Ask the breastfeeding service provider to give you a detailed bill complete with the corresponding insurance code numbers. Attach the doctor's prescription to the insurance form. This is more likely to make it through the system.
- If your claim is denied, call the case manager and explain why the service or equipment was necessary. You may need to educate the insurance company as to the health benefits of breastfeeding and how it will save them health care costs for both the infant and mother.
- Make the insurance provider aware that the American Academy of Pediatrics passed a resolution recommending that 3rd party payers provide or reimburse for lactation services as a cost effective measure.
- Submitting your claim several times, each time with fuller explanations, has been known to work so keep on trying.
- Explore your insurance provider's policy towards breastfeeding services before the need arises.