FAQs

Breastfeeding

What types of issues/topics can be addressed in a lactation consult?

Lactation consultant can address a number of breastfeeding-related topics in a visit, including:

Prenatal counseling for breastfeeding
Evaluating how much milk your baby is taking at each feeding session
Examining infant position and latch
Flagging (but not diagnosing) potential infant mouth issues such as tongue-tie, lip tie, etc. and suggesting follow
Helping address milk supply issues, nipple pain, breast pain, and mastitis
Co-developing breastfeeding strategies to manage challenging situations such as mom and/or baby medical conditions, preemies, or multiples
Teaching about pumping and storag, weaning, bottle feeding
Developing strategies for the return to work, including managing your supply and a pumping schedule

What can I expect from a typical lactation consultant (LC) visit?

Initial visits typically last between 1.5-2 hours.

Unless you’ve provided this information prior to the visit, the LC will ask you about you and your baby’s health, including your birth experience, prior breastfeeding experiences, and any underlying health conditions. For the baby, she’ll ask about:

Weight at birth and weight checks since
The number of wet and dry diapers daily
Breastfeeding experience to date with this baby
Any specific concerns you have

During the visit, any or all of the following will occur:

She’ll observe the baby’s physical appearance and behavior
The LC will observe a feeding session
She will weigh the baby before and after to assess milk intake (in the case of most in-home and virtual plus visits). During virtual plus (with scales) visits, an LC will drop off a medical-grade infant scale at your home to allow you to weigh the baby before and after a feed. Purely virtual visits do not typically use scales.
Check baby’s latch, breathing, sucking and swallowing while feeding
Correct positioning or any challenges she sees
Give you written instructions or protocols to follow for feeding
Refer you to any additional professionals to feeding-related issues as needed
Explain how to contact her for follow up questions and help

What is the difference between an International Board Certified Lactation Consultant (IBCLC) and a Certified Lactation Consultant (CLC)?

An International Board Certified Lactation Consultant (often called an IBCLC) has accomplished the most rigorous breastfeeding training available, which includes:

90 hours of lactation specific education
College-level health science courses
300 - 1,000 clinical practice hours
Successful completion of exam offered by an independent, international board of examiners

IBCLS are often engaged to support the most challenging breastfeeding cases and are the only providers that insurance will reimburse for.

Certified Lactation Counselors (CLCs) achieve their training through a number of different organizations, but training typically includes:

Between 20 - 120 hours of classroom training
Successful completion of a written exam offered by the training organization
Some clinical shadowing may be completed as well

Rates for CLC support are lower than IBCLCs and are not reimbursed by insurance.

Mom/Baby Nurse Care

How were the nurses and other providers chosen?

The providers in our network were carefully vetted from an engaged group of passionate professionals who are eager to support parents outside of a hospital setting. Many are mothers themselves, and deeply understand the importance of supporting/empowering families in this special time of their lives.

All of our providers have been rigorously screened for professional experience in postpartum, labor & delivery and pediatrics from top accredited institutions and hospital systems. In addition to having strong reputations in the local community, all providers have been background checked, have up to date vaccinations and have been interviewed for mindset. WellNested providers are sensitive, care deeply about supporting new families, believe in our mission to empower parents in their choices as well as remove burden from families so they can focus on enjoying this special moment in their lives.

For in-home visits, what areas do you serve?

How is this different from what I’m getting from my pediatrician, OB/GYN or hospital?

After delivery, your pediatrician will begin providing care tailored to your baby‘s needs within days of birth, but that won‘t include care for the birthing parent‘s physical or emotional recovery. Lactation support may or may not be offered in-office, and the level of lactation training can vary widely by practitioner.

Your OB/GYN office may check-in with you after birth, but in most cases, no post-natal check-ins will occur until your 2-week visit (for C-sections) or 6-week visit (for vaginal births).

Depending on when you‘re discharged from the hospital, you may be offered a single visit from a nurse associated with the hospital.

Even in the event of an uncomplicated birth, a tremendous amount of transformation and adjustment occurs in those 6 weeks! Our RNs ensure you have the support to physically recover from birth, mentally adjust to your new role and have the support, advice and clinical knowledge to take the best care of your new baby. All on a 1:1 basis and in the safety of your own home OR virtually.

Do you accept HSA/FSA funds?

Understanding Insurance

Can I use my insurance to cover any of WellNested's services?

Breastfeeding Support: Depending on your plan, insurance reimbursement is available for lactation consultant (IBCLC) visits. For more detail please read below
Mother/Baby Nurse: Currently, insurance reimbursement is not available for nursing care. However, we do accept FSA/HSA funds for payment.

What do I need to know about using insurance to cover a visit with a lactation consultant (IBCLC) booked through WellNested?

Since the Affordable Care Act became law in 2010, all new health plans are required to provide coverage for breastfeeding support and supplies. As expected, every health plan interprets that differently! We’re here to help you figure out how to use your coverage.

Only consultations from International Board Certified Lactation Consultants (IBCLCs) are covered by insurance. Certified Lactation Consultants can be booked at less-expensive rates, but are not covered. This is representative of the difference in their education and training.

Coverage type: Each plan offers different types of coverage, if at all
- In-network: Lactation consultants exist that are “in-network” for your insurance, meaning they bill your insurance directly and you don’t pay anything out of pocket
- Out-of-network: You have to pay out of pocket for the visit, and your insurance will pay all, some or none of the cost. Claims paperwork is required where reimbursement is possible. No worries - we can help you with that!
  - Any IBCLC can care for you if you have an out-of-network plan. No matter what, you need to submit a claim if you want reimbursement
- No coverage: Your plan doesn’t provide offer lactation consultant coverage.Coverage type: Each plan offers different types of coverage, if at all

Visit type covered: To our knowledge, if your insurance plan pays for lactation consultants at all, they will also be paying for virtual and virtual plus visits.

Likelihood of reimbursement
- Unfortunately, all insurance companies don’t play fair; some make it easy to get reimbursement and some fight it. We’ll let you know how likely it is to receive reimbursement because, we know, expenses with a baby absolutely add up
  - High likelihood: It is guaranteed that you will receive reimbursement
  - Moderate likelihood: Company might push back on the claim, but it’s likely you will see a payout if there is a coding error, or if you call
  - Low likelihood: Company historically fights claims, calling into question your true ability to receive reimbursement. It’s not impossible, just not guaranteed

How do we know this?
- Lactation consultants have been pursuing reimbursement for years and dealing with the paperwork. Their historical knowledge across many providers and billers informs our assessment.

If it’s not covered by my insurance plan, what do I do?
- Use HSA/FSA funding (if available)
- Call us! We can talk through local, group-based options that you might want to consider first

Insurance Coverage for Lactation Consultations

Massachusetts Based Plans Only

Insurer	Coverage Availability	Out of pocket expense	Likelihood of reimbursement?	# Visits Covered	Are there IBCLCs locally that accept your plan?
Aetna	In-network	No	Not applicable	Up to 6 per calendar year	Yes!
Allways	Out-of-network	Yes, but fully reimbursed	High	Unlimited (but may vary by plan)	No; you can find any IBCLC you like and submit for reimbursement
Blue Cross Blue Shield - MA	Out-of-network	Yes, but fully reimbursed	High	Up to 6 per calendar year	No; you can find any IBCLC you like and submit for reimbursement
Blue Cross Blue Shield - Federal	Out-of-network	Yes, 100% of the cost	No reimbursement	-	No
Cigna	Out-of-network	Yes, but potentially reimbursed up to 60%	Low Frequently denied the initial claim; requires multiple submissions	Unknown/undefined**	No; you can find any IBCLC you like and submit for reimbursement
Fallon	Out-of-network	Yes, but fully reimbursed (Excludes MassHealth members)	High	Up to 6 visits	No; you can find any IBCLC you like and submit for reimbursement
MassHealth	Out-of-network	Yes, 100% of the cost	No reimbursement Select MassHealth plans cover in-hospital or in-OB/GYN office lactation support only	0	No; you will need to find support via hospital or OB/GYN office
Harvard Pilgrim	Out-of-network	Yes, but fully reimbursed	High	Unknown/undefined**	No; you can find any IBCLC you like and submit for reimbursement
TRICARE	In-network (strict)	No	None Cannot pursue out of network providers Only IBCLCs/CLC visits covered if administered by a professional who is also a TRICARE-authorized doctor, physician assistant, nurse practitioner, nurse-midwife, or registered nurse.	Up to 6 outpatient sessions	Highly unlikely Please work through your TRICARE providers to connect with covered professionals
Tufts	Out-of-network	Yes, but fully reimbursed	Medium May ask for a letter of medical necessity from a physician	Unknown/undefined**	No; you can find any IBCLC you like and submit for reimbursement
Unicare	In-network	No	Not applicable	Unlimited	Yes!
United Healthcare	In-network	Depends Only in-network providers work in CT There are no in-network providers in MA	Low Requires gap exemption for MA residents to be obtained prior to visit*	Unknown	Yes!
Tufts Health Together	Out-of-network	Yes, 100% of the cost	No reimbursement	-	Yes, see our resources page here for more info www.bewellnested.com/resources
Tufts Mass Health	Out-of-network	Yes, 100% of the cost	No reimbursement	-	Yes, see our resources page here for more info www.bewellnested.com/resources

*Identify a lactation consultant you’d like to work with ahead of time and file a gap exemption with your plan to access reimbursement.

**Information is either unknown or undefined internally; no answer is available from the insurance company

FAQs

Breastfeeding

Mom/Baby Nurse Care

Understanding Insurance

Insurance Coverage for Lactation Consultations

Massachusetts Based Plans Only

Let's Connect

If you have any questions - or have an insurance plan not listed here - please reach out at hello@bewellnested.com or schedule a call with us!

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