Insurance woes

Insurance in this country is a mess. Most of our clients in the practice are insurance clients; our goal at Cuddles and Milk is to make lactation care accessible and affordable for as many people as possible. Most families we work with have employer health benefits that they spend thousands for a year (some clients pay thousands a month before accessing any care). People are choosing jobs just for the benefits and spending a lot of money even before they see a provider, and once they do the bills just keep rolling in, even for in-network providers. I just want to take a moment and talk about what insurance companies are doing.

First, I want to start with why we bill for both parent and baby at a lactation visit. While it’s true a baby doesn’t need help lactating, there is much more to a visit with an IBCLC than lactation. For a parent, we are assessing and supporting not just milk supply, nipple and breast health, flange fitting, but also sleep, mental health, screening for pelvic floor dysfunction, postpartum mood disorders, low milk supply including thyroid function, PCOS, insulin resistance, anemia, nutritional deficits. It’s so much more than just supporting the making of milk. For the baby we are supporting latch and breast/body feeding, but also oral function, bottle refusal, gut health/allergies, body tension, nervous system regulation and more. Babies need feeding support too!

UHC has made a recent statement that starting 9/1 they will no longer pay for babies; all lactation visits can only be billed to the parent. If a parent doesn’t have insurance (or has one that the IBCLC can’t bill) but the baby has UHC, they can’t get paid.

Aenta has been pushing again and denying baby claims for years. Most of the time I can get them paid but after MANY hours of work arguing with Aetna reps, asking for reconsiderations, sending medical records. It’s barely worth it when you consider the amount of time to deal with the billing.

Now BCBS is stating that babies don’t need lactation visits, that those are only for the parent. What about the baby with tongue tie that needs oral habilitation? What about the baby that has bottle refusal and can’t eat? What about the baby that has bloody diapers and no one can figure out baby’s gut health issues? Those babies all need to be seen by a skilled IBCLC who can support them with their feeding needs.

So, what can you do? First start complaining to your insurance company. Whether it’s one of these or a different company make it known that you think babies need lactation care too. Even better, if your benefits come from an employer paid plan, complain to the HR department! Insurance companies are more likely to listen to employers than providers. If you have a perks bonus like Maven, Carrot, KindBody, Progyny, or Accolade you should call them and complain. The more places you can make it known that you want your baby to have care, the better.

In addition to that, know that as IBCLC’s we are advocating for you and your baby, we are pushing for reasonable care and reimbursement. However we also have to make a living and pay our staff and expenses. Most IBCLC’s I know are scrambling right now, trying to find a path forward that will put the cost where it should be, on the insurance companies, not on the families.

Know we see you, we know how hard it is to deal with the financial changes that come with a new baby, and are trying not to add to your stress. Help us advocate, push for insurance coverage for babies with feeding issues too!