We are partnered with both The Lactation Network and Wildflower to provide up front insurance covered visit for plans that participate with these organizations.

• For all other plans, we are a private-pay practice and do not bill insurance directly.

• However, many families are able to seek partial reimbursement from their insurance company by submitting a superbill after their visit.

• Insurance coverage for lactation services varies widely by plan, and reimbursement is not guaranteed.

Possibly. Some insurance plans offer out-of-network benefits for lactation services, even when the provider is not in-network.

After your visit, you may submit a superbill to your insurance company for consideration. Some families receive partial reimbursement, while others do not.

We encourage families to contact their insurance provider directly to ask about:

• Out-of-network lactation coverage

• Preventive maternal health benefits

• Network gap exceptions

In Michigan and many other states, lactation consulting is a credentialed specialty (IBCLC), not a separately licensed provider type for insurance credentialing.

Because of this:

• Many insurance plans do not offer direct contracts to IBCLCs in private practice despite the ACA requiring covered lactation care

• Coverage is often limited, inconsistent, or handled as out-of-network care

• This is why we partner with 3rd party organizations like TLN and Wildflower when able for select plans

This is a system limitation — not a reflection of medical necessity or quality of care.

A superbill is a detailed receipt that includes:

• Provider name and credentials

• Diagnosis and procedure codes

• Date and cost of services

You can submit the superbill to your insurance company to request out-of-network reimbursement. Most plans have specific reimbursement forms on you member portal that need to be filled out and sent with a superbill. Some portals also have an online process for this.

We provide superbills for all out-of-network visits upon request.

BCBS of MI underwent a lot of changes in lactation coverage in 2025. Some Blue Cross Blue Shield PPO plans offer out-of-network reimbursement for lactation services, including some out of state plans. BCN often does not provide coverage for lactation services with a private practice IBCLC. Calling your plan is the best way of knowing what might be covered. If you have a BCBS of MI plan, here is their reimbursement request form. This may also be available in your online BCBS portal.

However:

• Many BCBS plans do not have in-network IBCLCs available. This means you can request a gap exception. This is a request to cover our services at an in-network rate if there are no in-network providers in your area or to be seen in a timely manner.

• Coverage decisions are made on a case-by-case basis

• Appeals are sometimes required

We provide documentation and appeal templates to support families when claims are denied, and can be found in FAQ #12 below.

A network gap exception is a request for insurance to treat an out-of-network provider as in-network when:

• No qualified provider is available within a reasonable distance or timeframe

• Care is medically necessary and time-sensitive

Many families seeking lactation care qualify for network gap consideration due to limited access to in-network IBCLCs. We provide Gap Exception template letters for you to send to your provider on request!

Yes. Breastfeeding support and lactation counseling are recognized as preventive maternal health services under federal law.

However, insurance plans differ in:

• How they define “qualified providers”

• Whether coverage applies in-network only

• How preventive services are reimbursed

This is why coverage varies even when services are medically appropriate.

Yes — we support families by providing the following:

• Detailed superbills

• Appeal letter templates

• Network gap exception templates

Families are responsible for submitting appeals and communicating directly with their insurance company. As we are out of network, we do not communicate directly with insurance plans.

FAQ #12 below re: templates has links for you!

Unfortunately, NO, we cannot guarantee coverage. TLN and Wildflower have their own policies on guaranteed coverage, so please reach out to them regarding their coverage. For out-of-network plans with a superbill, insurance reimbursement is never guaranteed.

By scheduling services, clients acknowledge:

• Full financial responsibility for services rendered

• That insurance decisions are made solely by their insurer

• That payment is due at the time of service

We will provide supporting documentation however for you to advocate for the lactation coverage you are legally entitled to! You can find links for these in FAQ #12 below.

We recommend calling your insurance company and asking:

“Does my plan offer out-of-network reimbursement for lactation services provided by an IBCLC?”

Also ask about:

• Preventive maternal health benefits

• Network gap exceptions

• Required documentation

Our National Provider Identifier (NPI) numbers, and the codes we most often use for lactation billing are below. Please have these on hand when calling your insurance plan. They may also provide the codes they accept, and if so, you can provide these to us at your visit.

Families often choose private-pay lactation support because:

• Care is timely and accessible

• Visits are longer and more individualized

• Home visits are appealing to families especially with newborns

• There are limited in-network options available

• Early lactation support can prevent more costly medical care later

We are passionate about supporting families in advocating for the coverage they are entitled to! We have developed templates for you to use in your communication with your health plan.

If you are a TLN or Wildflower patient, these are not for you! You will want to communicate with TLN or Wildflower directly for any billing concerns. These are for out-of-network families requesting reimbursement.

Click the links below to access templates. They are Google Doc files. You can copy and paste the text into your own document editor (such as Word), or make a copy of these using "File" -> "Make a Copy" if you use Google Docs to have an editable version. Please pick the template of the provider with whom you worked. We have also added Appeal packets to help you navigate these steps!

If you have already been seen for a visit and would like a Provider Justification Letter to send with your appeal, please reach out by email or send a portal message!

How to Appeal an Insurance Denial for Lactation Services

Abbie

Checkbox Appeal Packet

Appeal Letter - Lactation Services Denial

Network Gap Exception - Future Visit

Network Gap Exception - Past Visit

Tiffany

Checkbox Appeal Packet

Appeal Letter - Lactation Services Denial

Network Gap Exception - Future Visit

Network Gap Exception - Past Visit