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What if I want a visit but I don't have Aetna, Cigna or United Healthcare and I don't qualify for a covered visit with The Lactation Network? 

 

If your insurance plan is not one that I can bill directly, you still may be able to receive reimbursement for lactation services. The Affordable Care Act requires insurance plans to cover lactation support; however, many families find that accessing this benefit is not always straightforward. Insurance companies may refer you to a physician who holds an IBCLC credential but does not offer private lactation consults, or to an in-office lactation counselor who cannot see families outside of their specific medical practice.

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You do have options. Below are steps you can take to request pre-authorization for coverage before your visit.

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Steps to Request Pre-Authorization

1. Request an “in-for-out” authorization or a "gap exception." 
   Contact your insurance company and ask if they will authorize an out-of-network IBCLC (me) to be treated as if I were in-network.

2. Ask for the request to be expedited.
   Document everything:

   • the name of the representative you spoke with

   • the date

   • the case number

   • the authorization number

   • Request written confirmation of the authorization.

3. Request coverage for multiple visits.
   Ask for unlimited visits. If they require a specific number, request 8 visits.

4. Clarify that IBCLCs are not medical doctors.
   This helps ensure your request is processed correctly under lactation support benefits.

5. Plan to pay upfront.
   You will pay out-of-pocket at the time of service. I will provide you with a detailed superbill to submit to your insurance for reimbursement.

6. Ask how to submit for reimbursement.
   Your insurer will send any reimbursement directly to you (the subscriber). I do not bill your insurance on your behalf, even with approval, because they do not issue payment directly to providers.

7. Provide procedure and diagnosis codes.
   Common codes used for lactation visits include:

   • Procedure codes: S9443 or 99404

   • Diagnosis code: Z39.1 (Maternal Lactation Care)

   • Ask which codes your plan prefers.

8. Provide my business information (if requested):

   • Legal Business Name: Sweetly Nourish Lactation & Baby Care, LLC

   • Tax ID / EIN: 87-1396736

   • NPI Number: 1447841192

 

The National Women’s Law Center and their toolkit includes helpful information for speaking with your insurance provider. You can find the toolkit here: https://nwlc.org/wp-content/uploads/2015/08/final_nwlcbreastfeedingtoolkit2014_edit.pdf

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CONNECTICARE:

 

Connecticare usually covers 1 home visit within the first two months postpartum. I recommend calling to confirm your plan's breastfeeding benefits and inquire if there is a limit on how much they will reimburse you. You will be responsible for the consultation fees at the time of service but will be provided the necessary forms to submit for reimbursement.

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Payment is taken at the time of visit. The following payment methods are accepted: credit card, Venmo, PayPal, Apple Pay, or cash. HSA or FSA cards accepted. I will give you a super-bill at the end of our visit that you can submit to your insurance for possible reimbursement. 

 

 

I travel to all locations in Hartford County, Connecticut as well as Hampden County, Massachusetts. Please contact me directly for travel outside of these areas. All inquiries considered! Please note there is a $75 travel fee for any initial home visit within my travel radius, and a $50 travel fee for any follow-up home visit. Any travel beyond my travel radius will be subject to a higher travel fee, based on location. Please contact for details. 

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