Insurance rejected claim for lactation specialist

[EpdTTC]

Does anyone have experience dealing with this? I had a follow up appointment with one of the lactation consultants that I worked with while my daughter was in the special care nursery for two weeks because she was nearly six weeks premature. We were having trouble with breast feeding due to her prematurity so I met with her for more professional assistance. I actually have a yeast infection on my nipples from her and blisters from her latch. My insurance is calling the lactation consultant appointment an optional educational service. WTF is wrong with this world? I should have known the *******s wouldn't cover it after they rejected my claim for a hospital grade breast pump because they believe breast pumps to be a convenience item (and that was after the neonatologist wrote a letter of medical necessity stating my daughter needed the medical benefits of breast milk especially because she was premature). Apparently my insurance company believes lactation consultants aren't real medical professionals and that Breastfeeding my premature baby is unimportant. Anyone else face similar issues?

 

[TigerLady]

I haven't, but it doesn't surprise me. I could rant about US insurance companies and their practices for hours.

You might not have a great deal of recourse. You can submit a letter of appeal, but make sure you follow their procedures to do so if you want any hope of them changing their minds. See if the specialist is willing to provide a letter, too, stating this was not an "educational" visit, but a medical necessity for you and your daughter.

From now on, if you need assistance and don't want to pay the going fees, look for other sources of help. Do you have a LLL chapter near you? Also, look for family resource centers, many of them have lactations specialists on staff. See your OB/GYN for problems with thrush and medications for it. Or your pediatrician. That way the visits and the meds will be covered.

If your insurance never covered your pump, you can deduct the cost from your taxes next year. At least that is something.

I'm so sorry you are going through this. I can't count the number of times I've fought with my insurance company since having kids. Fought about things that should have been a "no-brainer", like covering emergency surgery for my 3 week old and covering CDC recommended vaccinations.

 

[EpdTTC]

I appreciate your response and your empathy tiger. Sounds like you have had your share of battles too!

I do have a local LLL that I've yet to check out but may do so. Also found an awesome breast feeding center about 40 minutes away. They have all of the supplies etc that you can usually only find online and a great lactation consultant who also has a masters in nursing and only charges $30 for the initial consult with limitless free follow ups! I have no idea yet what the charges will be for the visit my insurance won't cover. I may try and appeal depending on the charge but it may be a lost cause.
Thanks again for your support!
Erin

 

[Rydia]

I would doubt that your insurance company will cover BF related expenses I havent heard of them being covered before. Which is a shame because the insurance companies would save themselves money in the long run by encourging breastfeeding because that would lead to healthier babies and less claims.