FAQs

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Breastfeeding

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Essential Care Bundle for Parents & Baby

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Understanding Insurance

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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

InsurerCoverage AvailabilityOut of pocket expenseLikelihood of reimbursement?# Visits CoveredAre there IBCLCs locally that accept your plan?
AetnaIn-networkNoNot applicableUp to 6 per calendar yearYes!
AllwaysOut-of-networkYes, but fully reimbursedHighUnlimited (but may vary by plan)No; you can find any IBCLC you like and submit for reimbursement
Blue Cross Blue Shield - MAOut-of-networkYes, but fully reimbursedHighUp to 6 per calendar yearNo; you can find any IBCLC you like and submit for reimbursement
Blue Cross Blue Shield - FederalOut-of-networkYes, 100% of the costNo reimbursement-No
CignaOut-of-networkYes, but potentially reimbursed up to 60%Low Frequently denied the initial claim; requires multiple submissionsUnknown/undefined**No; you can find any IBCLC you like and submit for reimbursement
FallonOut-of-networkYes, but fully reimbursed (Excludes MassHealth members)HighUp to 6 visitsNo; you can find any IBCLC you like and submit for reimbursement
MassHealthOut-of-networkYes, 100% of the costNo reimbursement Select MassHealth plans cover in-hospital or in-OB/GYN office lactation support only0No; you will need to find support via hospital or OB/GYN office
Harvard PilgrimOut-of-networkYes, but fully reimbursedHighUnknown/undefined**No; you can find any IBCLC you like and submit for reimbursement
TRICAREIn-network (strict)NoNone 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 sessionsHighly unlikely Please work through your TRICARE providers to connect with covered professionals
TuftsOut-of-networkYes, but fully reimbursedMedium May ask for a letter of medical necessity from a physicianUnknown/undefined**No; you can find any IBCLC you like and submit for reimbursement
UnicareIn-networkNoNot applicableUnlimitedYes!
United HealthcareIn-networkDepends Only in-network providers work in CT There are no in-network providers in MALow Requires gap exemption for MA residents to be obtained prior to visit*UnknownYes!
Tufts Health TogetherOut-of-networkYes, 100% of the costNo reimbursement-Yes, see our resources page here for more info www.bewellnested.com/resources
Tufts Mass HealthOut-of-networkYes, 100% of the costNo 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

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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!