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As part of The Lactation Network, TLN, your insurance may cover your visits with up 100%

Insurance companies currently participating with The Lactation Network include United Healthcare Blue Cross PPO, Blue Shield PPO, Anthem PPO, Cigna PPO, Humana PPO, All Multi-Plan, and PNOA plans, with more being added.

Click to check eligibility

If TLN is not working with your insurance company of course, we will provide each client with an insurance reimbursement superbill. This will have all proper codes for submitting a request for reimbursement for services rendered or necessary lactation products, directly to insurance companies. Because we are International Board-Certified Lactation Counsellors (IBCLC), our professional services do qualify for patient reimbursement under many insurance plans.

To help determine what your insurance company will cover, you may want to ask your insurance company:

  • ​Do I have an out-of-network benefit if I see an out-of-network provider for lactation in my home or as an office visit?
  • Do I have a deductible or co-pay for out-of-network services?
  • Do I need a pre-authorization for out-of-network services?
  • How many sessions will the insurance company authorize before a treatment plan is required?

The common service codes (also referred to as CPT codes) that we use for sessions are:

99241 for the clinic
99341 for in-home
99201 for telehealth appointments.

Please remember

The client is responsible for paying for any consultation services or products, on the day services are rendered, regardless of the insurance policy or likelihood of. Here is an article from Women’s law centre it may be useful to read before calling your insurance company for reimbursements.

According to the Affordable Care Act of 2012 most health insurance companies require covering breastfeeding support, supplies and counselling that relates to the new baby(ies). The law says, most insurance companies should cover a home visit from an IBCLC. But as with any kind of insurance reimbursement, this may not be the case for one of the many reasons. So please call them ahead of time (we can even give you the CPT codes that we use for both in-home and clinic consults) and learn about their policies and what they will and what they will not cover. Make sure to record the time and date of the call, who did you speak to and what they told you (I usually ask them to repeat and take notes) they usually have a recorded copy of the conversation if there is any dispute happens but being prepared with this information makes thing much easier for you if you need to “remind” them what they told you previously.

If you are low income or having financial difficulties, please do not let this to be a barrier to getting the services you deserve. A sliding scale consultation may be available to you, to ensure lactation help and information is accessible to all who need them.