How to Get Reimbursed

 for a Breastpump or Breastfeeding Consultation with our Internationally Board Certified Lactation Consultants (IBCLC)

Healthy Horizons can provide you with a superbill, which is an itemized form used by healthcare providers for reflecting rendered services. A superbill is the main data source for the creation of a healthcare claim, which may be submitted to payers (insurances, funds, programs) for reimbursement. Healthy Horizons is not in network with insurance providers. Alternatively, we can provide a receipt for your Health Savings Account (HSA). If you pay by HSA you will not be reimbursed. 

 

Try to obtain prior authorization for your breastpump or lactation consultation if possible.  Prior authorization (PA) is a requirement that your physician obtains approval from your health insurance plan to prescribe a service or medical equipment. Healthy Horizons is a Durable Medical Equipment (DME) provider. This means many insurance companies will allow members to buy or rent breastpumps out-of-network with coverage ranging from 70% to 100% from us. Please call your insurance company to verify.

 

It is your responsibility to find out what your company and insurance provider will reimburse. If you are unable to receive reimbursement Healthy Horizons cannot reimburse you and does not refund the cost of a consult, group, class, or medical equipment. Depending on your insurance company the range for reimbursement may vary. Medi-Cal and Kaiser do not reimburse. For Anthem Blue Cross Blue Shield we recommend requesting an out-of-network exception or gap exception. Out-of-network exceptions or gap exceptions for preventative health services may work for other insurance companies.

Claim Denials and How to Dispute Them

Please note that claim denials are common with insurance companies. You will need to be clear with your insurance company that they are in violation if they cannot offer you an in-network provider within 60 minutes or 30 miles of you. They may tell you that they only cover in-network providers, even when they cannot offer you an in-network provider. This means they are in violation. 

 

In order for them to reimburse your expenses, you will have to demonstrate you know they must cover lactation services.  Please review these resources to better understand your coverage and how to dispute your claim denial. 

 

Facts and Tools to Understand Your Coverage

(Covers lactation consultations, and equipment such as breastpumps) 

 

Sample Insurance Phone Call Script

 

Sample Insurance Appeal Letters

for Lactation Consultations & Breastpumps


When you call your insurance company, record the case number, the name of the person you speak with, and log the call. If you are told they have no in-network providers and will not cover out-of-network services, they are in violation. You can contact the National Women's Law Center to take further action.

Corporate Coverage (It Is Your Responsibility to Verify This Information)

For Google employees, your Blue Shield insurance typically covers unlimited lactation consultations for 100% of the cost.

 

For Facebook employees, your Aetna insurance should reimburse 6 visits ranging from 70% to 100% of the cost. If billing under lactation consultation does not work, we can bill under breastfeeding class. 

 

 

Please note, that you pay Healthy Horizons directly and are reimbursed by your employer or insurance.

If you are unable to be reimbursed you are responsible for the costs.

 

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