Breastfeeding Services: Insurance Reimbursement

The California Breastfeeding Coalition is interested in your feedback on your experience with insurance reimbursement for Breastfeeding Support, Services, and Supplies. This information will be shared with our partners to advocate for improved reimbursement of breastfeeding services in California.

* 1. Please check one to identify yourself.

Healthcare Provider

Mother and/or Family Member

* 2. Type of insurance plan billed:

HMO

PPO

Emergency Medi-Cal (state of California card)

Managed Medi-Cal (state of California card and local plan card)

Other (Please specify).

* 3. Name of Insurance Plan:

* 4. Were you seeking or billing for: (Check all that apply).

Breastfeeding help

Breast pump

Breastfeeding supplies

Pasteurized human donor milk

Other (Please explain).

* 5. What was the date of service (approximately)?

Date

MM /

DD /

YYYY

* 6. At the time of service, the mother was:

Pregnant

In Hospital for delivery

1-3 weeks afterbirth

4-6 weeks afterbirth

7-9 weeks afterbirth

10-12 weeks afterbirth

Beyond 12 weeks

* 7. Was your insurance claim denied, delayed or paid? (Check all that apply).

Denied

Delayed

Paid

Never submitted an insurance claim. Please explain.

* 8. What reason(s) was/were given for help or supplies not being covered/paid for?

* 9. What other problems did you experience in providing or receiving Breastfeeding Support, Services and Supplies?

* 10. What other successes did you experience in providing or receiving Breastfeeding Support, Services and Supplies?

* 11. May we contact you for further information or to clarify?

Yes

No

* 12. Contact Information:

Name:

Address:

State:

ZIP:

Email Address:

Phone Number:

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