Edited 7/1/2024: Find out if you are able to skip this entire step by getting your benefits verified through The Lactation Network. You may be eligible to recieve your lactation care with little to no out of pocket expense to your family. For those who do not qualify with The Lactation Network, please read below for info on how to possibly get your services covered.
Some insurance companies have lactation consultants in their network of providers which means you many be eligible to see an in network IBCLC with the cost of only a copay. But if you do not have IBCLCs in your insurance network, then you will need to pay for your care out of pocket. You would then submit a claim to your insurance company to be reimbursed for your care. However, they do like to deny the claims. Your best bet for getting your lactation care covered when you have out of network benefits is to file for a GAP exception while you are pregnant or very soon afterwards. This gap exception means you are requesting the insurance company to pay for an out of network provider as if they are in network- essentially filling the gap they have in their network by not having credentialed IBCLCs in their network. See below for how to do this. Share with a friend.
