We have a simple ask: Allow Board Certified Lactation Consultants (IBCLCs) to join Anthem and BCBS network and cover in person lactation services for California Families!

Why we’re speaking up?

Because in June 2025, families in California with BCBS and Anthem lost their Lactation Coverage... It's October, and nothing has been done about it. Nothing! Tens of thousands of new mothers now can't access covered lactation support. 

When a newborn can’t latch, a parent’s supply dips, or pain makes feeding impossible, timely, in-person help from an International Lactation Consultant care can be the difference between a thriving breastfeeding relationship and a crisis that leads to ER visits, early weaning, and long-term health impacts for both mother AND her baby. 

Yet in California, families with Anthem/BCBS coverage are routinely denied access to IBCLC in person care!

IBCLCs are not even allowed to join the network directly, and claims billed for PREVENTATIVE lactation services are being are denied.

This is a preventable access problem and blocking IBCLCs from the network means families can’t use their benefits for the experts specifically trained to help!

The Affordable Care Act (ACA) §2713 and the HRSA Women’s Preventive Services Guidelines require coverage without cost-sharing for “comprehensive lactation support and counseling by a trained provider” in accessible settings. That means in person IBCLC care!

Across the country, major payers - including Aetna and UnitedHealthcare - credential IBCLCs directly and reimburse common preventive counseling and screening codes in outpatient and home settings.

Recently, after public reporting and community advocacy, Anthem expanded access to IBCLC network enrollment in Virginia, acknowledging the need to better serve families.

California families deserve the same!!!

What we’re asking Anthem/BCBS plans in California to do?

• Credential IBCLCs as independent, in-network providers.
• Allow IBCLCs to enroll and bill under their own NPIs for covered services.
• Cover lactation care outside the hospital.
• Reimburse S9443 (lactation education/counseling) and related preventive counseling and health screening codes for outpatient, office, and in-home visits without requiring “incident-to” billing.
• Publish a fair, transparent fee schedule aligned with national peers (e.g., Aetna, UHC; Empire BCBS NY) and usable POS codes for clinic and home care.
• Enable standard preventive and E/M pathways commonly used by payers for IBCLC services when within scope (e.g., S9443; 96156 behavioral assessment where applicable; 99401–99404 preventive counseling; 99202–99215 established/new patient E/M when compliant with payer policy).
• Create a clear provider portal pathway labeled “Lactation Consultant / IBCLC” for network enrollment and claims processing, so families can actually find and use covered care.

What this change means for California families?

• Healthier babies: Early, skilled lactation help reduces dehydration/jaundice readmissions and lowers risks of infections and later chronic disease.
• Healthier parents: Breastfeeding support is linked with lower postpartum depression/anxiety and reduced lifelong risks (including certain cancers).
• Lower system costs: Preventing feeding complications and avoiding unnecessary physician-level billing saves money -for plans and families.
• Equity and access: Removing network barriers expands care to rural/underserved communities and those who can’t pay out-of-pocket.

Our lived experience:

“I was told my plan ‘covers lactation,’ but no one in network could actually see us. By the time we found help, my supply was gone.” — California parent

“We’re trained, certified, and already in-network with other major payers. We simply need Anthem/BCBS in California to credential IBCLCs so families can use the benefits they pay for.” — IBCLC, California

The law is clear. The solution is simple. The moment is now.
Anthem and BCBS plans in California: follow the ACA/HRSA preventive care standard, align with peers, and let IBCLCs in. Families shouldn’t have to fight their insurer during the most vulnerable days of postpartum!

Parents, clinicians, and community supporters: Please add your name and share this petition so California’s families can access the care they are promised.

Media & Policy Contacts:

IBCLC Spokespersons: Karolina Ochoa BSN IBCLC, Clinical Director at Inland Breastfeeding Center located in Redlands, California -hello@inlandlactation.com

Parent Story Leads: available upon request, with media access to multiple families affected

 
Appendix :

The ACA and HRSA Women’s Preventive Services Guidelines require no-cost-sharing coverage of comprehensive lactation support and counseling by a trained provider — not limited to hospitals or physicians.

IBCLC = International Board Certified Lactation Consultant: the only board certification specific to clinical lactation care; widely recognized as the gold standard for breastfeeding management and complex feeding challenges.
Precedent: In 2025, after public scrutiny, Anthem in Virginia updated its enrollment process to allow more lactation providers into network. California can and should do the same.

Operational fixes for plans: add an “IBCLC” taxonomy pathway in credentialing; enable POS for office/home; allow direct claims under IBCLC NPIs for preventive lactation codes; publish rates.