Some private health funds do cover lactation consultation, usually under extras cover, but it varies a great deal between funds and between policies, so you need to check with your own fund before you book. There is no Medicare rebate for these visits at all.
This is what that looks like when you are trying to claim.
Is there a Medicare rebate?
No. Private lactation consultations are not covered by Medicare, so there is no rebate to claim and no item number to look up. Whatever you pay for the visit is what the visit costs you, unless your private health fund contributes.
That surprises people, and it is worth knowing up front rather than discovering it at the point of claiming.
What might private health cover?
Lactation consultation appears on the extras side of some policies. Whether it is on yours depends on your fund, the level of extras you hold, how long you have held it, and what you have already claimed in the year.
I cannot tell you what your fund covers, and I would not guess. Two people with the same insurer and different policies can get very different answers. The only reliable source is your fund.
What should you ask your fund?
Call them, or use the app, and ask these things directly:
- Whether lactation consultation is a benefit on your specific policy.
- Whether it needs to be provided by an International Board Certified Lactation Consultant (IBCLC).
- What the benefit amount is per visit, and how many visits you get in a year.
- Whether any waiting period still applies.
- How they want the claim submitted. Some accept a photo of an invoice through the app, others want it posted or emailed.
Ask before you book, not after. If the answer is no, you can still decide the visit is worth it, but you will be deciding with the real number in front of you.
What invoice do you get?
You will get an itemised invoice for every consultation. It includes my IBCLC registration number, the date, the service provided and the amount paid, which is what most funds ask for when they assess a claim.
If your fund wants something specific that is not on there, like a particular code, a provider number in a certain format, or a different description, tell me and I will do my best to give you an invoice in the form they want. It is much easier to fix at the time than months later.
What if you are not covered?
Plenty of families are not, and still find the visit worth doing. If cost is the deciding factor, there are lower-priced ways in. A telehealth consultation gives you a proper assessment and a plan without the home-visit price, and a follow up costs less than an initial session. The full list is in the article on what a lactation consultant costs.
There are also free services. The Australian Breastfeeding Association helpline runs 24 hours a day, and your local hospital's maternity unit will take a call about your baby at any time.
Can you claim on the day?
Not through me. I do not have on-the-spot claiming, so you pay for the visit and claim it back from your fund yourself with the invoice. Most funds are quick about it once they have the paperwork they asked for.
If you would like to talk about which type of consultation makes sense before you get into the insurance question, that is a fine reason to get in touch. You can also read what happens during a home visit to see what you would be claiming for.