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Breastfeeding and Your Insurance Coverage

Updated: Sep 6, 2023



The Affordable Care Act (ACA) requires all new health insurance plans (including employer-provided plans) to cover lactation support, counseling, and equipment for nursing mothers. This is great news for mothers who want to breastfeed, but are worried about the cost. Let's take a look at what exactly is covered under the ACA.





What's Covered?

Breast pumps and other breastfeeding equipment are now considered preventive services and must be covered by new insurance plans with no out-of-pocket costs to you. This means that if your insurance plan covers preventive services, you should not have to pay a co-pay or deductible for a breast pump.


In addition, many insurance plans must also provide lactation counseling and support from a lactation consultant without any out-of-pocket costs. Lactation consultants can help you with everything from getting started with breastfeeding to dealing with common issues like latching problems, sore nipples, and engorgement.


If your employer provides your health insurance, they may also be required to provide you with reasonable break time and a private space (other than a bathroom) to pump breast milk during the workday.


In-Network

Green Living & Wellness is in-network with

  • Medical Mutual of Ohio and will submit claims directly to them.

  • We also have the ability to submit claims for most BCBS PPO, Anthem PPO, Cigna PPO, and Humana PPO plans as well as most plans that utilize MultiPlan and PNOA for 100% coverage.

Please note that PNOA and MultiPlan logos will appear alongside other payers on the medical insurance card. If the card includes the PNOA or MultiPlan logos, we may be able to take them.


We partner with The Lactation Network for some billing so you may receive an email from them (for approval/denial) if your plan is one that they work with. Please visit this link to verify coverage.


Out-of-Network

  • We are approved for direct billing for OSU Health Plans. There will be no out-of-pocket fees for their members. If you have any questions, please email OSUHPBuckeyeBaby@osumc.edu

For other plans, the best way to determine your coverage is to call the member service number on the back of your insurance ID card and ask whether they will reimburse you for lactation support services by an out-of-network provider.


If we are out of network for your plan, we can submit the insurance claim on your behalf in an effort to make the reimbursement process easier. What does this mean? You would pay upfront, our office submits the claim to your insurance company, and all reimbursements go directly to you.


Superbill

A superbill (a list of all services provided) that has all the information your insurance company needs to start the process for reimbursement. Every company's process is different. If you would like to seek reimbursement on your own, I suggest looking into companies like Reimbursify or Better Claims.


Verifying Insurance

Verifying your benefits prior to your appointment is a great way to be clear on the specific coverage for your plan. Plan to have 15-30 minutes of your time available to call your insurance company. Make sure to have this information ready before your call:

  • Insurance card

  • Name, date of birth, address, phone number, or possibly social security number of the cardholder or person for whom the services are for

  • Pen and paper/notepad

Information to document during the call

  • Name of the customer service representative

  • Date of call

  • Time of call

The representative of your insurance carrier may ask for the following Green Living & Wellness information:


K.E. Green Speech & Language LLC dba Green Living & Wellness

Kellie Green, MA., CCC-SLP, IBCLC

Tax ID (EIN): 47-4739885

NPI Number: 1740928316

Lactation: L-310957

Procedure Codes: S9443, 99404, 99202, 99403, 99212, 96156, 98960

Location Codes: 11 (office), 10 (telehealth)

Address: 3600 Olentangy River Rd, Bldg D, Ste 107, Columbus, OH 43214

Phone: 614-974-2211

Fax: 614-974-2215


Medicaid & Managed Care Plans

Unfortunately in Ohio, lactation services are not covered by Medicaid or any of the Managed Care Plans, such as Caresource, Molina, Paramount, etc. Our office does offer 50% off all lactation services with proof of coverage.


The ACA has made it easier for mothers to get the breastfeeding support they need. If you're thinking about breastfeeding, be sure to check with your insurance provider to see what equipment and services are covered under your plan. With a little bit of planning, you can make breastfeeding work for you and your baby—without breaking the bank! Learn more about coverage under the ACA here.


To schedule with us, click below.



 

About the author: Kellie Green is a certified and licensed Speech Pathologist, as well as an International Board Certified Lactation Consultant (IBCLC), who specializes in infant feeding. She operates a private practice in Columbus, OH, Green Living & Wellness.





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