The affordable care act of 2012 requires coverage of lactation consulting as a “Women’s Preventative Service”.
First thing you should know. Insurance companies don’t want to help you get reimbursed for your lactation consultant visits. They are counting on you becoming frustrated and giving up pursuing reimbursement. Pro Tip: Have your husband or partner call and talk to the insurance company. Dealing with insurance companies in the first 6 to 12 weeks postpartum is not a job you should have to do.
If you’re working with a Lactation Consultant (LC) who isn’t “in-network” with your insurance company (like me for now) you might have to pay the LC directly and then submit a superbill to your insurance for reimbursement. Obviously, this isn’t ideal, but unfortunately, many Lactation consultants are “out of network” due to the fact that insurance companies aren’t sure how to credential and contract with IBCLC’s. Here’s an unfortunate fact. There is an annoying loophole that allows health insurance companies in the United States to claim that they cover breastfeeding support and supplies as per the Affordable Care Act, even though they won’t allow IBCLCs to be in-network providers. And that’s why the superbill is needed.
Okay. The Superbill. So, what exactly does this mean? How would you go about getting reimbursed for a lactation consult using a superbill? I will provide you with a document (called a superbill) that you will submit to your insurance company for them to reimburse you for the money you paid to Nichole McCloy, LLC for your lactation consult.
Here are some more quick tips to help make the process as easy as possible:
◦ A National Provider Identification (NPI) number and tax ID (EIN) number. *These numbers will be listed on your superbill
◦ A code for the type of appointment (CPT code)
◦ A code for the problem (ICD-10 code)
◦ The amount you paid.
◦ The date of service.
◦ The IBCLC’s contact info and signature.
Although this can take a few weeks, most families do see some level of reimbursement at their out-of-network rate depending on the health insurance plan. Sometimes you’ll be fully reimbursed with no questions asked, and other times you might have to “fight for it”.
The good news: if you’re working with me, I'm happy to set up a payment plan for you! I know money can be tight when you’ve got a new baby! (Don’t hesitate to ask me about this.)
