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 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.

    1. You have two options:  

      1. See who you like and file for reimbursement afterwards and see what they do.

      2. 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 challenges. Explain who you would like to see and follow their guidelines for how to file. In most cases you will file a HCV 1500 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.

    1. Provider: Lisa Weinshenker

    2. Provider NPI : 1902175078

    3. TAX ID: 832011452

    4. Company Name: Breastfeeding and Babies LLC

    5. Diag Code: z39.1

    6. Billing codes: 99401-99404 and S9443

    7. If they need a range of visit time put in 6-8 weeks then you will not have to file again.

Copyright 2018 © Breastfeeding and Babies L.L.C. ; Lisa Weinshenker, RN, BSN, IBCLC