Prior to working directly with your insurance company, please go to The Lactation Network and submit your insurance information, along with your request for a consultation with one of our Lactation Consultants. If your insurance is not in partnership with the Lactation Network you will receive an email informing you of that. Our Lactation Consultants will accept payment prior to the consultation, then after the consultation you will be provided with a Superbill necessary for you to seek insurance reimbursement.
This list is for informational purposes only – we cannot tell you what your insurance will or will not cover. We suggest following these steps to get specific information for your insurance plan and processes:
This list is for informational purposes only – we cannot tell you what your insurance will or will not cover. We suggest following these steps to get specific information for your insurance plan and processes:
1. Register as a plan member on your insurance website and create an account with a password. That allows you to view the claims that have been filed on your behalf, as well as the status of any claim you submit. You should be able to find the process for submitting a claim; if you don’t find it, call member services, or customer service, for your insurance plan.
2. Contact your insurance company to find out if they have particular forms or instructions for members to request reimbursement,
3. Submit documentation of your visit to your insurance company via our consultant-provided Superbill, or using the plan-specific forms provided by your insurance company, along with your policy information. Visit documentation should include:
◦ A National Provider Identification (NPI) number and tax ID (EIN) number.
◦ A code for the type of appointment (CPT code), such as a home visit.
◦ A code for the problem (ICD-10 code), such as slow weight gain in
newborn.
◦ The amount you paid.
◦ The date of service.
◦ The IBCLC’s contact info and signature.
◦ A National Provider Identification (NPI) number and tax ID (EIN) number.
◦ A code for the type of appointment (CPT code), such as a home visit.
◦ A code for the problem (ICD-10 code), such as slow weight gain in
newborn.
◦ The amount you paid.
◦ The date of service.
◦ The IBCLC’s contact info and signature.
4. If your claim is denied: Because coverage of Lactation services is new for many insurers, some companies are still sorting out what to cover, and confusion is common. These suggestions may help if you have difficulty getting reimbursement.
- Make sure you understand the reason – occasionally a claim just needs to be resubmitted under the mother’s name instead of the baby’s, or vice versa, or more information is necessary. Some companies may ask for a referral from your Pediatrician or OB/GYN.
- If you are told that you must see a provider in your network, or a provider who is a doctor or nurse practitioner, request a list of IBCLC providers that you can see. If they do not provide one, consider appealing your claim, because this is not meaningful coverage.
- Submit an appeal, including the Superbill information along with (SEE SAMPLE APPEAL LETTER BELOW):
- The reason you sought help, especially mentioning if your Pediatrician or another healthcare provider referred you.
- Anything you were told on the phone by the company.
- Whether they failed to give you a list of IBCLCs that would be covered.
- Some insurance companies are still unfamiliar with the IBCLC credential. They may ask for a copy of your provider’s state license – There are only a few states in the U.S. that have established licensure. Some IBCLCs are also nurses and may have an RN license. Most independent IBCLCs are not RNs, and therefore use only the NPI# for insurance claims.
- Consider including this information sheet, especially if your company seems unclear about what an IBCLC is:
- If you feel that your insurance company is not complying with the ACA requirements, or handling your claim appropriately, consider filing an insurance complaint with Florida’s Chief Financial Officer at https://www.myfloridacfo.com/Division/Consumers/needourhelp.html
| sample_appeal_letter.pdf |