What is Covered?                     

As mandated by the Affordable Care Act (the ACA, also referred to as "Obamacare"), insurance companies are required to provide coverage for "Comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum period, and costs for renting breastfeeding equipment...subject to reasonable medical management, which may include purchase instead of rental of equipment"  


In addition, "Coverage of comprehensive lactation support and counseling and costs of renting or purchasing breastfeeding equipment extends for the duration of breastfeeding."


This means that your insurance company can opt to pay for rental of a hospital grade breastpump and the supplies required to use it, or they may opt to purchase a pump for you, as this would likely be less expensive to them in the long run. This was clarified by federal government in February of 2013, so all insurance companies should be well versed in assisting you with this benefit.


Here's the Catch...

What is "comprehensive lactation support and counseling," and who is a "trained provider?" Unfortunately, those are things that haven't been clarified yet. Some insurance companies have suggested that physicians and nurse practitioners are the only "trained providers" they will accept; while other companies have recognized that the IBCLC is the qualified "trained provider" in lactation. Until this issue is clarified, it will be up to each person to advocate for themselves and make sure that Registered Lactation Consultants are covered.


To this effect, it is worth noting that it has been clarified that, "if a plan or issuer does not have in its network a provider who can provide the particular service, then the plan or issuer must cover the item or service when performed by an out-of-network provider and not impose cost-sharing with respect to the item or service." This means that if you insurance doesn't have a provider "in-network" that is trained to give "comprehensive lactation support and counseling," they are still required to cover the services in full. 


Many insurance companies will initially insist that all services must be performed by an in-network provider; however, a proactive and vocal person can (and should) advocate for themselves to get services covered. Unfortunately, this is usually a long and arduous process.


So what does this mean for you?  It means that although you will have to pay for you consultation at the time services are provided, your insurance company should cover the cost of your consultation and any breastfeeding equipment you may need. However, because I do not participate or accept any insurance plans, you will have to be proactive and insistent in working with your insurance in order to make sure that you are reimbursed for your expenses.


*Reference: http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs12.html