Out-of-Network Insurance Coverage

• Prenatal Consultation $150
• Initial Consultation: $215
• Follow-up Consultation: $175
• A sliding scale is also available

At Nurturing Traditions, we’re committed to helping as many clients as possible get insurance coverage for our lactation services. However, some insurance plans don’t contract directly with lactation consultants, meaning we can’t bill them on your behalf. In these situations, you can submit a superbill to your insurance company for potential reimbursement.

We know that as a new or expecting parent, dealing with insurance can feel overwhelming. But, you pay for your health insurance, and it should cover what’s required by law!

Your Right to Coverage!

The Affordable Care Act (ACA) mandates that “Health insurance plans must provide breastfeeding support, counseling, and equipment for the duration of breastfeeding. These services may be provided before and after birth.” The only exceptions are state-funded healthcare plans and “grandfathered” plans (those that existed before the ACA was enacted). In 2015, the United States Department of Labor further clarified aspects of the ACA regarding lactation coverage.

What to say to Your Insurance Provider:

When you contact your insurance provider to inquire about coverage, the National Women’s Law Center offers a helpful script (available on page 8 of their document).

We recommend you also ask your insurance company to provide a list of in-network lactation consultants within a 60-minute drive of your location. It’s often difficult for them to provide this. If they can’t, you can request “gap coverage” or “network deficiency coverage,” which means they’ll cover an out-of-network provider (like us) as if we were in-network.

Don’t Give Up!

Especially here in Michigan, where International Board Certified Lactation Consultants (IBCLCs) are scarce, insurance companies sometimes use loopholes to deny coverage. This can be frustrating, but it doesn’t mean you won’t get coverage. Insurance companies often rely on the fact that people won’t pursue denied claims. Some insurance experts even suggest it can take up to four claim submissions before a claim is paid. It’s worth the effort!

Investing in Your Breastfeeding Journey:

If, for any reason, your insurance company doesn’t cover the cost of our services, please know that paying out-of-pocket means you’ll receive the highest quality breastfeeding support available in our area. We are passionate about what we do, deeply committed to helping families achieve their breastfeeding goals, and strive for excellence in every interaction. We’re confident you’ll find our support invaluable.