Insurance Coverage / Reimbursement
For select in-person and virtual lactation visits, I'm excited to announce that I have partnered with The Lactation Network! This in an incredible organization that helps parents and parents-to-be get the breast/chestfeeding support they deserve, covered by their insurance. I encourage all parents to apply if you have any commercial health plan as TLN is adding more plans all the time.
For select health plans, Lactation Network guarantees at least six, 90-minute, in-home lactation consultations with a registered IBCLC, like me, at no out of pocket cost. They handle the paperwork and bill your insurance directly. Pre-approval is required and is obtained online through Lactation Network. Participating plans are select:
BCBS PPO Plans
Anthem PPO Plans
Cigna PPO Plans
United PPO Plans
PNOA (Provider Network of America)*
*These is the networks name, not your carrier. There are many different insurance plans under various names that participate in these networks. Look for the PNOA or Multiplan logo on your insurance card.
Select plans from the above insurance providers may not participate with TLN. Apply to verify coverage
Once you receive your approval (often within a day), go ahead and schedule your visit online!
To see if your plan participates and get pre-approved, apply online!
For Out-of-Network Plans, lactation consultation fee is due at the end of our visit together. You may use a Health Savings Account or Flexible Spending Account to pay for your visit. I also accept major credit cards, cash and check. I will then provide you with an electronic receipt called a Superbill. This is a special invoice with insurance codes that you may submit to your insurance company to request reimbursement.
If your insurance plan does not participate with Lactation Network, you are still entitled to insurance coverage of lactation support and supplies per the Affordable Care Act. It states "Health insurance plans must provide breastfeeding support, counseling, and equipment for the duration of breastfeeding. These services may be provided before and after birth. This applies to Marketplace plans and all other health insurance plans, except for grandfathered plans." (https://www.healthcare.gov/coverage/breast-feeding-benefits/)
If you are planning on submitting your visit for reimbursement, it is your responsibility to know your plan's coverage. It is always best to call the number on the back of your insurance card and ask about lactation coverage. If they say they will not cover my services because I am out-of-network, ask if there is an in-network IBCLC in your area. If not, they must cover out-of-network providers as a "gap exception" because there is not an in-network provider. If can also be helpful to ask what insurance codes they cover related to lactation support if they will provide you with that information. It may be helpful to have the following information ready for them if they request it:
My Provider Number: 1902346380
Procedure Code Used: S9443
Diagnosis Code Used: Z39.1
Insurance companies aims are first and foremost to make money, and so at times deny claims illegally.
The National Women's Law Center has great information about insurance companies, what should be covered, and reimbursement. They have helpful scripting when talking to your insurance company in their Breastfeeding Toolkit available for download.
Some insurance companies require a referral or prescription from your Obstetrician before covering your visit and can improve the likelihood of getting reimbursed. You can call your provider's office to request this.
If you would like to arrange a payment plan, please let me know at the time of booking and you will be billed in installments. If you anticipate paying for services would be a financial hardship, please contact me. I am willing to work with lower income families to come up with a reduced price or payment plan based on your income. I can also refer you to some local free support groups.
Go ahead and and schedule your visit online!
Some insurance plans cover prenatal classes either in whole or in part. It is always worth calling the number on the back of your insurance card to determine if they will cover your classes. Class fees are due at the time of booking, and you may use an HSA / FSA card or other major credit card. If you would like to submit a reimbursement claim to your insurance company, please let me know. After you have attended your class, I will provide you with an electronic receipt called a Superbill. This is a special invoice with insurance codes that you may submit to your insurance company to request reimbursement. These are the codes I use for each class. You may want to ask your insurance provider if they cover these codes:
Lamaze Childbirth Series
(Procedure Code: S9436 Diagnosis Code: Z32.2)
(Procedure Code: S9442 Diagnosis Code: Z32.2)
(Procedure Code: S9443 Diagnosis Code: Z32.1, Z32.3)
(Procedure Code: S9444 & S9447 Diagnosis Code: Z32.3)
(Procedure Code: S9437 Diagnosis Code: Z32.2)
(Procedure Code: S9445 Diagnosis Code: Z71.89)