Birth, Baby!

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Welcome, this is Birth, Baby.

Your hosts are Ciarra Morgan and Samantha Kelly.

Ciarra is a Birth Dula, Hypnobirthing Educator, and Pediatric Sleep Consultant.

Samantha is a Birth Dula, Childbirth Educator, and Lactation Counselor.

Join us as we guide you through your options for your pregnancy, birth, and postpartum drain.

Today we have Naiomi Catron with us to talk about a couple of warnings you need to know before ordering a breast pump.

Thank you for being here today, Naiomi.

It's my pleasure.

I love chatting with you guys.

Awesome.

So can you tell us about just kind of what it looks like to have insurance cover lactation and breast pumps, what that looks like?

Yeah, now we are really lucky that more insurances are starting to cover lactation benefits.

So I would say 70% of private PPO insurances cover lactation consultations.

And they usually cover anywhere from three to six, and some plans are unlimited based on medical necessity or the necessity that the provider thinks they need.

So yeah, it's really well covered.

Awesome.

So is there a large number, a large percentage of people that come to y'all that have insurance that will cover lactation visits?

I would say in our practice, well, probably 70% of our patients are using their health benefits.

So they're not having to pay upfront usually anything.

And then we do the billing, and that comes into another whole fun mess sometimes.

Yeah, tell us about that a little bit.

I think the first challenge is many times some insurances say your visits are 100% covered.

And they say like some cards say it's 100% in-home visits covered at 100%.

And so what they don't tell you is that those are for like 40-minute visits.

And anything over that, there's going to be a little bit of cost sharing.

So perhaps a deductible will apply.

Many times if you've had your baby though, your birth can hit your deductible.

So that's pretty cool.

But insurance companies can get creative and apply copays still for anything over.

I don't want to say 40 minutes exactly because it depends if it's an initial visit or a follow-up visit.

But sometimes people heard, like they call their insurance the way they're supposed to and verify, hey, this company or this provider, they're approved for lactation services like they'll check Milk Diva or my name.

And they say, yes, you're covered up for six visits at 100 percent.

But they don't say those six visits are less than X amount of minutes.

And they don't say anything about virtual consultations if that's 100 percent covered or not.

So that can get a little tricky.

So we do a lot of education before someone books and we send a lot of forms and talk with people and tell them what to expect.

So they're not surprised.

And then I will say that many of us in town work with a third party billing company.

I'm not going to like go into the actual names, but once you fill out this little form online for them, they do say you're 100 percent covered and that company will absorb any additional fees.

So many times, if you have like Cigna or Anthem, you would qualify to get your visits covered by this third party billing company.

And then if for some reason the insurance wants to apply a copay, that billing company, the third party billing company, does not pass that on to the patient and they absorb the entire cost.

That's huge.

That is huge.

For us, we also take Aetna Insurance and they're the ones where it gets a little tricky because they promise their clients or their members, I should say, the world.

And that's not how they reimburse us.

And it's not 100% usually covered.

The insurance world is so tricky.

And we have questions from clients all the time prenatally about everything from things covered in pregnancy to my labor, to if my kid gets my if I get discharged before my baby does, now is my baby having to have their own copay or deductible?

And we're like, we don't know.

We can't answer all these questions.

We've been saying lately, we really want like some insurance insider with billing come in and talk to us.

I do a lot of insurance stuff because we I mean, it's my business.

I want to make sure I don't go to like what you call insurance fraud jail or something like that.

But one thing people may not know is that if your baby, let's say, has a tongue tie release in the hospital, the baby has not met their deductible.

So the mom had a birth and that birth will get billed to the mom's insurance or the birthing parents insurance and they will meet their deductible usually.

The baby is brand new, has no charges on their insurance because the birth should be a global fee.

That means they charge the hospital one time for the birth and the well care of the baby.

But now the baby gets circumcision or gets a tongue tie release.

Those are not standard well care and that's not usually included in the what we call global fee, which is a flat fee for the birth and the care of the newborn in the hospital.

And then they get this tongue tie release and they think everything is great.

And then a few months later, they get a ginormous bill.

And it's basically an inpatient surgical bill, which is a lot compared to if you would have maybe just added your baby to dental insurance for like four bucks a month and gotten it done with a pediatric dentist outpatient.

Oh my goodness.

It's so messy.

It's so messy.

We want to do a whole episode.

We're just trying to find all the people we need to talk to you for that.

So when it comes to lactation and all of these things, what are some of the things that you find are roadblocks when trying to use these benefits?

What issues do people come across?

I think the first issue is waiting too late.

It's very difficult to have a brand new baby be in pain, be uncomfortable, and then try to call your insurance and have all the things make sense.

Of course, as a lactation consultant, my soapbox is please get prenatal education.

Connect with a lactation consultant before you deliver.

Book your lactation consultation while you're still pregnant for a week after your due because you don't want to be scurrying and need someone now and then find out there's a week or two wait.

So lots of patients are taking advantage of getting prenatal education, but they're sometimes doing it kind of on accident.

They go to order their pump and then the pump company is offering some prenatal classes.

And they say they're free.

And so they take them.

They're kind of like in a Zoom meeting, like a webinar.

And you'll have a lactation consultant or a nurse.

I don't know the qualifications of the person giving the class and tips and maybe going through a slideshow.

And that's the end of that.

And they usually sell you a package of four or five classes like Newborn Care, Intro to Breastfeeding, Postpartum, like things, just general kind of teachings.

And then they say it's free because it is to the patient, but they bill your insurance.

And they bill your insurance of preventative code, which to be exact is S9443 if anyone wants to know.

And that code is for 71.

Well, for every insurance is different, but it's about $70.

And so you never see a copay.

You don't have to pay for it.

It's considered preventative and they call it a lactation class.

So most insurances will permit you to have X amount of lactation classes.

Usually it's between three and six.

Well, if the pump company told you the classes were free, which they are to you, kind of, but they build your insurance for four prenatal classes, then you have a baby and now you really need some hands-on customized help.

That webinar and that Zoom call is not appropriate for them.

When you go to your lactation consultant, they say, Oh, you have XYZ insurance.

Great.

You have six visits covered.

They see you, all the things.

And then we usually bill your insurance about 45 days later.

We wait for your birth to hit your deductible.

So our claims don't cause a problem.

And then we find out, oops, you have six visits with us, but then it looks like you have four additional visits from this other person, this other provider, and it will come up with like a brand name.

Sometimes it's the hospital pediatrician will actually bill in addition to their global fee.

And you're like, Oh, now I have to send this patient a bill for whatever, 70 times X amount of dollars is.

And so that is a big surprise that I have seen happen a lot more just in the last year.

So when you're saying that they're counting these packages of four or five classes as lactation classes, you just said that they could be newborn care classes, but they're qualifying all of those as lactation classes and using those against the lactation benefit.

Yes.

I mean, this is the thing.

All these things are like there's nuances.

So it depends what diagnosis they put with it.

So there's every with every billing code, there has to be a diagnosis.

And so the ones that we use on lactation land is usually care of a lactating woman.

But there's another diagnosis code like, you know, post or prenatal.

There's other codes which I don't know because I don't bill.

So they use that code and then they put an education class on top of it, lactation education.

And so that does kind of if the code at the diagnosis is prenatal care, and then you put a lactation class on top of it, that's kind of OK.

I'm not an auditor.

I don't know.

And I don't know that anyone is going to audit their charts.

Right.

So what you're saying is it's kind of tricky for the consumer to know what they're going to do.

What they're going to be charged for.

And the big warning here is if you're being offered any sort of prenatal classes by an external company and they're saying that they're free, make sure it's not, oh, it's free to you, except that not later because you're going to be charged for things that you weren't going to be charged for if you hadn't used this benefit.

Yes.

And when it comes to like pump companies do this a lot, they're going to send you an email and in a small print, it says it in there, but we're not usually reading this.

I don't usually read that stuff.

So that's what you should know.

Just like your mama probably always told you, nothing in this life is free.

And so they're making their money somewhere and they're billing your insurance and you don't realize it.

And so just kind of like a PSA, nothing is ever free.

And while prenatal education is very important, I know for a fact that taking a prenatal class in town is if you have to pay cash, you can use your HSA card many times.

Like our prenatal coursework and all our prenatal stuff, you can just swipe your HSA card and you're what, fifty, seventy dollars one time and it's like personalized care and you're in our system and it's just you.

And you get all these resources afterwards, like all these PDFs and all this helpful information, like insider secrets, not a generic cookie cutter for the masses type webinar presentation.

I feel like if parents knew that I would rather pay for quality and have one awesome paid for prenatal class or education versus some Walmart approach to prenatal prep and then get my insurance charged $70 times 4.

Like if you think about it, 70 times 4 is $280.

You know how many awesome prenatal classes and courses you could probably learn how to deliver your own babies for, you know, I'll see an extra.

And it gets so tricky because after you have a baby, you might end up needing a lot of lactation care and, you know, follow up visits and all these other things.

Like it's not you don't typically get one lactation visit and everything is dealt with and you're good to go.

You typically you're going to need some help and it may even be further down the road in your breastfeeding journey that you need some help.

And then you come back and find out that, oh, well, yes, your insurance covers six visits, but you used four of them by this class that you didn't even know was using four of them.

And that it just makes it makes life so hard because then you're having to pay out of pocket for these visits that are even more expensive than just paying for those classes would have been.

Yeah.

And that's what is breaking my heart recently.

I didn't see this.

I've been probably billing for like four years or five years, and it's not this is just something I just started enough.

It's been a year in the fall that I started seeing it.

And it does break my heart because really, I don't know when you first have a baby, you don't know anything about insurance because you're usually healthy.

And you usually have not had to go in.

You start to learn about insurance when you start taking your kid to the doctor.

And you're like, oh, every time I go in for a weight check or like it's I think it's a well check.

But then I tell them my baby has a runny nose and they bill it and sick visit and what's the copay versus deductible versus max out of pocket.

And so you don't learn that stuff till later.

And it does.

It really takes the wind out of people's sail when their baby is six months old and then they get all these bills that they thought were covered.

And sometimes like maybe us, like maybe our company might get the brunt of the wrath.

Like, no, you build wrong.

I'm sure it was covered.

I was told it was covered.

Or you said, yeah, you said I had six covered visits.

Yeah.

And so we do check the insurance before usually they have their visit with us.

And if the other company has billed already, like a pump company will bill because you're still pregnant.

So that will come up.

But the hospital, if the pediatrician in the hospital is going to use your lactation benefit also, because they came in and said, keep breastfeeding.

Good job.

Like whatever they do, I don't know that they spend a whole 90 minutes with you like a lactation consultant would.

If they use that code, there's no way for us to know that until a few months later when that bill hits your account.

So you can't tell a pediatrician not to bill your insurance lactation because you kind of can't.

But what you should know is at least for pump companies and anything that's advertised as free, read the right, read the fine print.

And you might want to pass go on that and just invest in the money and getting a high quality, individualized prenatal consultation because it is really important.

And I just tell you guys, and I know, Naiomi, you did not know I was going to say this, but can I just shout out you real quick because you make no extra money by hopping on here and giving this warning to people.

You're still going to get paid at the end of the day, whether people use these lactation visits with you or whether they used them prenatally by accident.

And then they have to pay you because they still have to pay you.

But it just means so much to me.

And like that you care so much about the community at large that you want to get out here and tell people this because again, you make zero dollars and zero cents extra from telling people this.

And it just shows how much you care.

I appreciate that.

I thought you were going to say, I make zero money billing insurance.

And I'm like, yeah, how did you know that?

Yeah, yeah, actually, you lose money billing insurance, actually.

But I mean, like so many people need to care.

And I just like, I'm not trying to get rich, but I also can't.

Like I have to pay staff and I have to pay for all the things.

So but I just break my heart for a new parent who wants to breastfeed or whatever their feeding goals are and for their insurance to tell them one thing and then behind the scenes, there were some sneakiness going on that's just not transparent.

And I just that is that is just we're a vulnerable population, like pregnant women or like new moms and babies.

Like it's super vulnerable.

And I just I think there's a really unfair to take advantage of that that population.

Yeah.

Yeah.

You're speaking our language here.

That's for sure.

So quick question.

Would lactation visits in the hospital, like, you know, all the hospitals have their lactation counselors that come around and visit new moms.

Are they billing for that as well?

Or is that covered under that birth umbrella?

As far as you've seen so far?

That's such a great question.

Yeah, I've heard in other parts of the country that they are billing for those lactation visits.

However, here in town in Austin, I've not come across a hospital system at the current time whose lactation provider is covering.

And so one little thing that might make you put a red flag up and think maybe they'll charge me is, and I don't know if most like I don't know if patients know this or not.

If your hospital, if the lactation consultant's paycheck comes from the hospital, they are usually not going to bill your insurance.

If the lactation consultant is like a third party company.

So they're they have an outside lactation LLC, and then the hospital has contracted them to come in and provide lactation services.

They may do their billing separately.

I have not seen that happen in town here in Austin yet, even though we have both models.

But I have heard of other hospital systems in other parts of the country doing it that way.

And it was such a great question, Samantha, because we do.

We have people put it on their birth preferences sheet.

I want to see the lactation consultant within 24 hours of birth, because why not if it's included?

But is it like part of that global fee or is it an additional cost?

So that's a great question, Nick.

If somebody is just unsure, just ask.

Yeah, I think they could totally ask that question, but that is an excellent question.

Every hospital is going to be different.

I am not a billing.

I don't know anything about hospital billing necessarily.

I do know there is something called a global fee.

What's included?

What's not included?

What time that global fee, like how many days after birth that global fee is done?

I'm not sure, but an OB would know a little bit about that.

And then the hospital pediatrician could also speak to that.

Hospital pediatricians many times are not employed by the hospital.

They are employed through a third party.

And so you can ask the hospital pediatrician that comes to see your baby, does your company bill for lactation?

They may or may not know, but they can find out.

That's great.

Gosh, this was so informative.

And I got I mean, there's just there's so much here.

I think Ciarra is absolutely right.

We're going to have to do like a whole probably a whole series on insurance someday and like do some investigative reporting or something and get into it, because it's wild and so many people just don't know anything about it.

But thank you so much for coming on.

We really appreciate you coming on and sharing your knowledge with us.

And we hope to have you back soon.

Oh, we're going to.

You don't have a choice.

We're waiting for you to come back, Naomi.

And everyone, please check out.

She also has a podcast and we will link that in the show notes too.

Go take a listen to hers.

Do you want to say real quick what the name of that is?

Well, if I remember my podcast name.

I know, because I think you changed it.

It's like a long name now.

It is Boob Business with Milk Diva.

So you can actually just type in Milk Diva in the podcast player and it'll pop up.

But Boob Business is so good.

Y'all, I was on her podcast a few weeks ago, and I shared it with my work dad, who I talked about in like episode two of this whole podcast.

And I sent him a message saying, Oh, look, I was on another podcast and he wrote back with Boob Business.

I just made a mid 50 year old man listen to a podcast about Boob Business.

He's a better man for it.

Thank you guys for having me down.

Thank you for joining us on Birth, Baby!

Thanks again to Longing for Orpheus for our music.

You can look him up on Spotify.

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See you next week.