If you’ve done any research into pregnancy or breastfeeding in the United States in the past few years, it’s likely you’re aware that the Affordable Care Act expanded preventative health care services to include breastfeeding support- as of August 1, 2012, health plans in the United States were generally required to cover “breastfeeding support, supplies and counseling” in conjunction with each birth.
In the summer of 2012 I was already on pathway 2 to becoming an IBCLC (International Board Certified Lactation Consultant) and I was beyond thrilled to learn that insurance companies would be paying for my services. So many barriers to proper care would be removed! Families could get the help they needed from me and other IBCLCs without having to pay out of pocket! It was about damn time!
Everything is perfect, everything is grand! I’ve got the whole wide world in the palm of my hand!
Yet here I sit, 3.5 years later, and very little has changed on the insurance front for private-practice IBCLCs.
Clients ask me if their insurance covers my services, and I have to shrug my shoulders and explain that I am only in network for one insurance plan- Aetna. Most IBCLCs have cobbled together a workaround- we take our client’s payment and provide them with a superbill that can be submitted to insurance for reimbursement.
I can never guarantee my clients that their insurance company will reimburse them- even though the wording in the ACA’s Women’s Preventive Care Guidelines state that health insurance should cover:
Confused? Wondering how the insurance companies get away with not covering lactation support and counseling by a trained provider like an IBCLC when it’s stated as a requirement by the U.S. Department of Health & Human Services?
You’re not the only one.
I just love this guy.
There is a puzzle piece missing in this picture, and it has led to what seems like a gaping loophole in the insurance companies’ coverage of the services I provide.
That missing puzzle piece is licensure.
IBCLCs are not licensed providers in 48 of the 50 states.
Only Rhode Island currently licenses IBCLCs– Georgia is getting licensure set up now- and the majority of insurance companies will only contract with licensed providers.
Yes, there are some OBs, Nurse Practitioners, Pediatricians, etc. who are already licensed healthcare providers AND are also IBCLCs- they do provide lactation support to their patients (and that is a wonderful, wonderful thing). But there are currently NO licensed lactation support providers- no one who is licensed SOLELY for the practice of providing “comprehensive lactation support and counseling”.
Anywhere (other than Rhode Island and soon, Georgia).
They don’t exist.
Can you see the loophole now? Basically the (highly technical, super classy) way I see it is this:
ACA: Hey insurance companies, y’all have to cover lactation support! It’s important!
Insurance companies: Cool, ACA, happy to do that. We’ll pay for breastfeeding support from licensed IBCLCs, ’cause as you know, we only pay licensed peeps.
ACA: But… there’s no licensure for lactation consultants.
Insurance companies: Not our problem.
ACA: …not our problem either.
Insurance companies: Peace out!
As an IBCLC in private practice, I am very supportive of licensure for IBCLCs.
As I mentioned in a previous blog post, currently anyone can call themselves a “lactation consultant.” Licensure is viewed as a way to protect the public from potential harm; in healthcare, licensure certifies that the licensed individual has earned the minimum education and experience required to practice, and a licensed healthcare provider has to prove ongoing knowledge and skills in the field to stay licensed. According to the United States Lactation Consultant Association,
licensure therefore could be used to protect the
title of lactation consultant, provide a single set of
standards for the profession enable, autonomy of
practice and increase access to care, culminating in
support for billing and reimbursement.
In my eyes licensure for IBCLCs is a win-win situation. Families get the lactation support and counseling that they need, IBCLCs are held to a high standard of education and care, and families don’t have to pay out of pocket for preventive services. Yes, I will have to pay licensing fees. Fine by me. WORTH IT.
There is no process for national licensure, so each state licenses it’s own healthcare professionals. Currently 36 states have a group of people working on licensure initiatives for IBCLCs. In Massachusetts, where I live, Senate Bill 1183 is making it’s way through the legislature. It’s getting there, slowly… I hope. I’m doing what I can to help it along the way.
What can you do to get my services covered for your family in Massachusetts?
You can mail in that superbill I provide you at the end of our session, and if you are denied reimbursement, appeal. The National Women’s Law Center has put together a toolkit to help families understand their breastfeeding coverage and to help file appeals. And consider contacting your state and federal representatives and telling them that IBCLCs need licensure.
After all, 70,000+ babies are born in Massachusetts every year- almost 4,000,000 in the entire United States every year- and each and every one of them deserves skilled lactation care. On behalf of them, I thank you.
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