Insurance Coverage Issue for Lactation Services

[Anonymous]

I had a baby in May and saw a lactation consultant four times. At the time, there was one in-network for the DMV area, which clearly isn't sufficient. I saw someone else who had immediate availability and paid out of pocket. I then submitted to my insurance, BCBS, for reimbursement which they have since denied. Has anyone else had experience with this? I have written appeal letters, submitted medical claim forms, spoken with countless customer service people but had had no luck. I understand that these visits should be paid in full, thanks to the affordable care act. Any help or guidance would be greatly appreciated.

[Anonymous]

The ACA just requires one option be provided for most things —but insurance companies don’t have to make it convenient or decent quality. (Same with the breast pumps—I had BCBS Fed and the only pump they’d cover is the Ameda Purely Yours, which is pretty universally known to be crap so I had to pay out of pocket for a decent one.) I just sucked it up and went to Metropolitan Breastfeeding in Bethesda, which was the only lactation consultant BCBS Fed covered in 2017 and they excluded at home visits so I had to trek my preemie newborn there on the metro. It wasn’t convenient but I wasn’t paying for that out of pocket too. Sorry, OP but I think you’re SOL on this one.

[Anonymous]

Anonymous wrote:I had a baby in May and saw a lactation consultant four times. At the time, there was one in-network for the DMV area, which clearly isn't sufficient. I saw someone else who had immediate availability and paid out of pocket. I then submitted to my insurance, BCBS, for reimbursement which they have since denied. Has anyone else had experience with this? I have written appeal letters, submitted medical claim forms, spoken with countless customer service people but had had no luck. I understand that these visits should be paid in full, thanks to the affordable care act. Any help or guidance would be greatly appreciated.

What is the reason they have given for denying you?

Also, where do you reside and where in the DMV was the lactation consultant located? If you lived in VA, and they were in DC then you have some basis or live in DC and they are in MD. I would see if they will let you try and submit a network gap exception that pre-dates to the date of service. It is unlikely but worth a try.

If that doesnt work then write a letter to a local newspaper or TV station.