The ACA Mandate — What It Means for You

Under the Affordable Care Act (ACA), most private health insurance plans are required to cover breastfeeding support, counseling, and equipment with no cost-sharing (no copay or deductible) when provided by an in-network provider. This includes visits with an IBCLC.

However, coverage details vary by plan. Some important nuances:

In-network vs. out-of-network. The no-cost-sharing mandate applies to in-network providers. If your IBCLC is out-of-network, you may still have coverage, but you could owe a portion of the cost.
Number of visits. Some plans limit the number of covered visits (for example, six visits per pregnancy). Others have no limit.
Grandfathered plans. Plans that were in place before the ACA took effect and have not been substantially changed ("grandfathered plans") are exempt from this requirement.

How to Check Your Coverage

Call the number on your insurance card. Ask: "Does my plan cover lactation counseling with an IBCLC? How many visits are covered? Do I need a referral?"
Check your Summary of Benefits. Look under "Preventive Care" or "Maternity/Newborn Care" for breastfeeding-related services.
Ask your IBCLC. Many lactation consultants — including those on Latched — can help verify benefits before your appointment.

What Is a Superbill?

A superbill is a detailed receipt that contains all the information your insurance company needs to process a claim for reimbursement. It includes:

Provider name, credentials, and NPI number
CPT codes (procedure codes) for the services provided
ICD-10 codes (diagnosis codes) for the reason for the visit
Date of service and session duration
Amount charged

If you see an out-of-network IBCLC, you can submit the superbill to your insurance company to request reimbursement. Latched automatically generates superbills for every session, making this process simple.

How to Submit a Superbill

Download the superbill PDF from your Latched account after your session.
Log in to your insurance company's member portal (or call them).
Submit the superbill as an out-of-network claim.
Your insurer will process the claim and send you a reimbursement check or direct deposit, typically within 4 to 8 weeks.

FSA and HSA Eligibility

Lactation consulting services are considered a qualified medical expense under IRS guidelines. This means you can use funds from your:

Health Savings Account (HSA)
Flexible Spending Account (FSA)
Health Reimbursement Arrangement (HRA)

to pay for sessions — even if your insurance does not fully cover them. Save your receipts or superbills as documentation.

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