07/04/2025
Hey, folks! There are a lot of insurance companies out there that are making it challenging for mothers and babies to receive lactation care, even when their plan says it's covered.
Let's talk about BCBS this week. They won't add IBCLCs to their network coverage in Tennessee. So when mothers are looking for in-network coverage, they can't find an IBCLC to help them *unless* they are in a hospital or clinic or hold another license. So, mothers need to pay up-front for their lactation care (that is "covered") and then submit for reimbursement. And *hope* their plan will pay. (Don't worry, we're keeping a running tally of plans that are reimbursing and just how long they take).
Here is how some mothers have been personally impacted this month because the delay in coverage in reality means a delay in their care:
1. Moms with babies who are not gaining weight well. They need continued feeding support and oral habilitation AT LEAST weekly to help these baby feed well. So far, insurance is reimbursing, but it's taking several weeks.
2. Several moms with very damaged ni***es who need continued support again with babies who are not feeding well. I would typically see these moms at least weekly and most of the time more often than that until they are able to breastfeed with healed ni***es and without pain. They are bleeding and also crying because they are worried they won't be able to see me.
3. Several mothers who are experiencing negative impacts on their mental health surrounding difficulties with breast AND bottle feeding. Normally we would touch base with these mothers 1-2 times weekly until feeding is going well.
4. SEVERAL babies who have had oral ties released and need continued follow-up care to ensure good, effective breastfeeding (remember, tie release is just a piece of that process and doesn't in itself make feedings perfect).
Y'all, this is just the tip of the iceburg. Millions of people are paying thousands of dollars for insurance coverage and then getting the run around when they need support.
MOMS HAVE BLEEDING NI***ES AND ARE WORRIED THEIR INSURANCE WON'T COVER THEIR LACTATION CONSULT.
-Why don't I move to a hospital or medical clinic? Because I won't limit the time or care I provide for breastfeeding mothers.
I won't limit you to 15-30 minute lactation visits so I can be compliant.
I won't be prohibited from telling you that your baby has oral functional issues and may need an assessment for oral ties (this happens locally!)
I won't schedule a boatload of moms in one day so I can make the most money.
There are other insurance companies who are equally as bad in different ways (one won't credential us and then points us to another company who literally only bills when we do all of the work, and my best guess is they are getting at least 50% of the total cost when we are the ones spending hours with these moms and babies). It's shameful.
I will be contacting people in places who can make a difference. I won't be silent that BCBS is failing mothers and babies when it comes to getting excellent lactation care. The path to become an IBCLC is rigorous. Mothers deserve to have this care covered without jumping through hoops.
If you have BCBS and your plan won't cover your care without paying up-front, let them know your opinions on that. Even though as a newly postpartum mother this is the VERY LAST THING you should be required to do. Again, it's shameful that you are owed care, and they won't make it easy for you to get it.
