Saturday, February 9, 2019

How to Get Reimbursed for Lactation Consultations!


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!