Three weeks after a medical biller announced it would no longer be working with Blue Cross Blue Shield of Mississippi, moms in the state face out-of-pocket costs of over $100 per session for breastfeeding help – and are calling on lawmakers and the state’s largest private insurer to step up.
Although Blue Cross has always restricted which lactation consultants it considers in-network – generally only covering services in hospitals provided directly after birth – moms with Blue Cross insurance previously had a workaround. A third party biller called The Lactation Network (TLN), which contracts with lactation consultants, covered the costs for women with the insurance.
However, on April 30, TLN sent out a letter to consultants saying their organization was not being reimbursed by insurance companies and could not afford to continue fronting the money to cover moms with certain health insurance – including Blue Cross Blue Shield of Mississippi, Louisiana and Alabama.
TLN did not respond to multiple requests for comment from Mississippi Today.
“You’re sitting there like: I’ve got to feed my baby, and something’s not right, and I can’t get help,” said Patience Pierini, a Gulfport mom of two. “… If, more than anything, people need nourishment, why is this not being covered?”
Erin Mattingly, a lactation consultant and birth doula, examines 1-month-old Maverick Saxton while speaking with his mother, Christie Saxton, at Erin Mattingly Birth Services in Madison, Miss., Thursday, May 22, 2025. Credit: Eric Shelton/Mississippi TodayThe recent development has prompted moms and lactation consultants to ask why Blue Cross never covered these services directly in the first place – which nurse practitioner and lactation consultant Laken Miller called “even worse” than dropping the coverage.
“We didn’t know before that the Lactation Network was just bridging the gap, and understandably, it was a cost that they couldn’t continue to absorb,” said Miller, who is an International Board Certified Lactation Consultant (IBCLC) – the highest form of accreditation in lactation care – in Laurel.
The only in-network lactation consultants currently covered by Blue Cross in Mississippi are physicians, who do not generally operate outpatient clinics focused solely on breastfeeding care. But there’s nothing stopping the insurance company from working with non-MD lactation consultants, explained Marsha Walker, president of the National Lactation Consultant Alliance.
Blue Cross operates independently in each state, and the restrictions on lactation services vary significantly. In Tennessee, they are slightly more lax than Mississippi, with the insurance company working with certified lactation consultants who also have nursing degrees, two consultants told Mississippi Today.
Blue Cross also did not respond to questions from Mississippi Today about why it does not cover non-physician lactation care in Mississippi or if it has plans to in the future.
Insurance companies are required by federal law to cover breastfeeding support, counseling and equipment. But they’ve been allowed to meet this requirement while offering limited access to few providers, or only covering virtual consultations, explained Walker, who is also a registered nurse and IBCLC.
Christie Saxton, left, prepares her 1-month-old son, Maverick Saxton, to be weighed during a visit to Erin Mattingly Birth Services in Madison, Miss., Thursday, May 22, 2025. Credit: Eric Shelton/Mississippi Today“The (Affordable Care Act) does say that breastfeeding counseling needs to be covered, but it doesn’t say how – and that’s the problem,” Walker said. “It’s general in scope, leaving it up to the insurers to figure out how to adhere to that.”
There were 97 IBCLCs in the state in 2023, but the vast majority of those work in hospitals and provide support to mothers during their stay following birth – which is typically long before mature milk comes in and various breastfeeding problems surface, Miller, the lactation consultant and nurse practitioner, explained.
Miller said she only knows of four IBCLCs besides herself working outside of hospitals in the state.
Last week, Miller and her colleagues sent a letter to state lawmakers asking that the Legislature ensure insurance companies are adequately fulfilling their obligation under the ACA to cover lactation care.
“We recognize that BCBS supports breastfeeding … However, the reality is that thousands of mothers in Mississippi will no longer have access to no-cost lactation services from private practice IBCLCs due to no available in-network or out-of-network providers,” the letter read.
Covering lactation services yields a huge return on investment for insurance companies, explained Walker, if it prevents even one infant’s stay in the neonatal intensive care unit for a condition like necrotizing enterocolitis (NEC), a severe gastrointestinal condition in premature infants that is made more likely by a diet of formula.
“If you do not cover breastfeeding, it comes back to haunt you later on with the increased amount of money they’re going to spend on diseases and conditions that are preventable by breastfeeding,” Walker said.
One study estimated each baby who is breastfed for three months saves private insurance companies $750 compared to those who are never breastfed.
For new moms, whether they have access to timely care will make or break their decision to breastfeed, explained Erin Mattingly, a Jackson-based IBCLC who also signed the legislative letter.
“When parents run into trouble in that 10-day to two-week period, if they don’t have access to help, the vast majority of them will quit breastfeeding,” Mattingly said. “Because it’s very difficult to push through a situation that feels dire when you are postpartum and recovering from a birth and learning a new baby.”
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