Blue Cross Blue Shield PPO
Anthem BCBS PPO
How to get your visit covered:
If you have one of the above insurance plans, please verify your eligibility at https://lactationnetwork.com/lactation-consultation/. Pre-approval is needed for coverage. At least 3 visits with Trish can be covered at no out-of-pocket expense for you IF YOU QUALIFY.
Select "Yes" or "Other" depending on your situation for "Did a Lactation Consultant refer you?"
Enter “Trish Wierenga” as the Lactation Consultant.
Fill out the remaining information on the website and submit.
You will receive an email from Lactation Network with information regarding your eligibility for 100% coverage. This email is frequently sent within hours of your submission.
Once you receive verification from Lactation Network, click on “Schedule an appointment” and choose an available time for your visit. If you do not see an available time listed on the calendar, please contact Trish to schedule.
**REMINDER - NOT ALL PLANS ARE COVERED. If you are not covered at 100% with your insurance, you may still schedule a visit with Trish, and she will give you a superbill to submit to your insurance for potential partial reimbursement. See information below on “Out of Network” coverage.
If your visit is not covered by the above process, services may still be covered directly by your insurance provider. Payment for the visit is collected from you at the time of service. A superbill will be provided at your request. You can submit the superbill to your insurance after the visit for possible reimbursement.
Affordable Care Act:
The Affordable Care Act states, “Health insurance plans must provide breastfeeding support, counseling, and equipment for the duration of breastfeeding. These services may be provided before and after birth.”
** Grandfathered plans are exempt
National Women’s Law Center:
Please visit this site when discussing coverage of IBCLC visits with your insurance company. In this toolkit, there is a wonderful sample script for calling your insurance company to determine lactation benefits.
From page 8 of the NWLC Toolkit:
Q: What if my insurance company doesn’t have any lactation consultants or breast pump supplier in-network?
A: If your insurance company doesn’t have any lactation consultants or breast pump providers in-network, the insurance company must cover services from an out-of-network provider without cost-sharing. Federal guidance makes clear 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.” If your insurance company does not have providers in its network to provide breastfeeding equipment or lactation counseling, you must be able to go out-of-network, the item or service must be covered; and covered at no cost-sharing.
What if I must pay out of pocket for a visit with Trish with no possible reimbursement from insurance?
You can still schedule a visit! Trish will provide you with the best possible care to help you reach your breastfeeding goals. The money you spend on a private practice IBCLC is worth the money to get you the critical assessment skills provided in the IBLCE Clinical Competencies for the Practice of IBCLCs.
If the Clinical Competencies were a bit heavy to read, a wise and wonderful IBCLC wrote a blog post breaking down the price of IBCLC home visits. See that post here: