How to get Reimbursed!
1. Call your insurance and find out if they are
contracted with anyone locally who is an IBCLC. You are entitled to lactation
consultation under your insurance (as long as not grandfathered in and true insurance) under the ACA (affordable care act). This is
a preventative maintenance under mom’s insurance, not baby.
2.
When reimbursed it is required to be as if you
saw someone in-network since this is an ACA provided service.
3.
For UNITED HEALTHCARE.
a.
You have two options:
i.
See who you like and file for reimbursement
afterwards and see what they do.
ii.
Call and begin a GAP exception. All info. needed
to file for this can be found below.
4.
For all other health insurance. Explain that you
need to see an IBCLC, not a CLC, RLC, or other number of letters that may be
out there. An IBCLC is standard of care for lactation consultation. Explain who
you would like to see IBCLC and follow their guidelines for how to file.
In most
cases you will file a form provided after seeing an IBCLC. Reimbursement may not be
the same as charges since in many cases charges include online, text, and phone
support which are not covered by insurance.
5.
Info needed for GAP exception or other paperwork
prior to consultation.
a.
Provider Name:
b.
Provider NPI :
c.
TAX ID:
d.
Company Name:
e.
Diag Code:
f.
Billing codes:
g.
If they need a range of visit time put in 6-8
weeks then you will not have to file again.
Good Luck and Be Strong, Lactation Consultation is your Right!
