medical insurance coverage and reimbursement

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The Lactation Network - ppo plan coverage

We have partnered with The Lactation Network in an effort to get more coverage by private medical-insurance providers (Cigna, United, and Blue Cross Blue Shield) for all lactation services. If you have a PPO medical insurance plan, this amazing organization will directly check your coverage, AND bill your insurance so payment is not necessary at the time of service. Our hope is to help shift the paradigm in making breastfeeding education, support, and resources, accessible to all families and improve the standard of care nationwide.

Learn more

Do you have a medical insurance PPO Plan?

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if the answer is yes, point your mobile device or QR code reader app to the QR code

The device will then recognize the QR Code and show a notification. Just tap on the notification, and you will be taken to our online form through The Lactation Network to check for medical insurance coverage.

………or just Click on the button below, and complete the form - it’s THAT EASY!

You will typically get a response within 24 hours to confirm pre-approval of medical insurance coverage for lactation services

don’t have a ppo plan? no worries, we can still help!

Since the Affordable Care Act mandated most private medical insurance policies to cover lactation services, it can and SHOULD be a reimbursable expense at 100% with no cost-sharing.  However, due to current legislation in NC, becoming “in-network” can be difficult for IBCLC’S. That said - We are not currently “in-network” with any private medical insurance plans or medicaid, due to the extensive amount of time that it takes to keep up with (for a small lactation practice like ourselves - there are just two of us!).

If pre-approval is unable to be obtained through The Lactation Network due to the type of insurance plan you currently have - we can still help! Payment can be made at the time of service and then provide you with a superbill that has the necessary medical coding and cost of services breakdown, which you can then submit for reimbursement through your medical insurance provider(along with their specific claims form).

You can always call your insurance-provider prior-to scheduling to ask about coverage for lactation services. Check out the Insurance Reimbursement Section under the Resources listed below for helpful tools regarding the filing process (pages 6-8 of the NWLC toolkit link have a great script to use - it’s a little lengthy but has great info - as well as a list of questions to ask if a phone call is made).

Did you know? Claims are often denied because most private medical insurance companies assume that our local hospital offers outpatient, individualized lactation care, therefore would be considered an “in-network” lactation provider.

However, our local hospital, New Hanover Regional Medical Center, does not currently offer outpatient lactation services. This means that once you are discharged, you can not schedule a lactation consult at the hospital. It is often necessary to educate your insurance provider that this is not an option and therefore is not a cause of denial for a reimbursement claim! If your policy states that lactation services are covered - they should be paid at 100% if there are no IBCLC providers available that are considered “in-network” within a 30-50 mile radius of your personal residence!

We send a letter to any Medical Insurance Providers that contact us requesting additional information regarding a claim submission. You can view a copy of this letter here

cost of services

This can vary depending on complexity, what services you need, and where you are located. Our community prenatal breastfeeding class is offered on a monthly basis at a reduced cost to all families, regardless of location (since we have gone virtual!) Additional services offered include individual and/or group breastpump classes, baby weight-checks, express-visits, and initial and follow-up lactation consultations in a variety of settings including: in-office, virtual (through a HIPAA compliant telehealth platform) , or in-home visits (that’s right, we come to YOU!). Costs of lactation services range from $50-$250 depending on complexity and duration/time-involved (specific to each appointment).

service area

Do you live outside of the Wilmington area? Have no fear, we offer virtual lactation consultations, and travel outside of New Hanover County (depending on location)! Due to driving time and the cost of gas, there is a travel fee for in-home visits located outside of a 10-mile radius ($1.00 per mile each way over 10mi). Contact us to inquire about scheduling outside of Wilmington, we will do our best to accommodate every family looking for breastfeeding support!

RESOURCES

medical insurance reimbursement

expressing milk/breastpumps:

“TIT-ILLATING” TOPICS:

general breastfeeding resources

Book recommendations:

  • The Nursing Mother’s Companion: Revised Edition, Kathleen Huggins

  • Womanly Art of Breastfeeding, La Leche League International

  • Making More Milk: The Breastfeeding Guide to Increasing Your Milk Production, Second Edition, by Lisa Marasco Diana West

  • For Working Moms:

    • Nursing Mother, Working Mother, Revised Edition, Gale Pryor and Kathleen Huggins

Local Resources:

WIC Resources:

  • New Hanover County
    Norma Escobar IBCLC, RLC
    910.798.6542
    910.798.6657

  • Brunswick Co. (Brooke Rhyne)
    910.253.2878 (Shallotte)
    910.253.2288 (Bolivia)
    910.253.2877 Jill (Leland)

  • Onslow Co.
    910.989.3954

  • Pender County
    WIC Director, Maureen Hubbard: 910.259.1294.
    BF Coordinator/IBCLC, Melanie Boullion (available Tuesday-Thursdays): 910.270.510

VIDEOS

We are so excited to collaborate with Heather Anderson from Blessed Nest to bring you some fun and educational video resources! Pregnancy and motherhood are not intended to be journeys that are ventured alone. We hope these videos will support,encourage, and empower you!

A shallow latch is one of the most common causes of nipple pain, and our hope is that this resource will help with getting the hang of a deeper latch! This video will show you some tips and tricks to getting a more comfortable latch with your baby including: how to support your baby at the breast, recognizing hunger cues, and techniques.

This one is for all the moms out there with brand new babies! The Cross-Cradle hold is another great option for those first few weeks postpartum, when babies can't support their own heads yet - check it out!

It's time to play football! As in, the football hold when it comes to breastfeeding that is 😊 We are teaming up with Blessed Nest to bring you this week's video discussing the football position, which can be helpful for Moms with larger breasts, had a cesarean delivery, have multiples, or just want to try a different angle. Remember, the purpose of these videos is to help some Mama's out who may be struggling with getting comfortable feeding a newborn! If things are already going well with nursing, latching is comfortable, baby's output and weight is on track, there is no need to change what you are already doing, there is no "right or wrong" way to nurse your baby! Shout out to all of you new Mama's, you are doing an amazing job! **This in no way should take the place of getting help from a Healthcare Provider

Have you ever wondered what really happens during a lactation consultation? Natalie breaks it down and explains what services LC's are able to provide and how they can help struggling mommas! Give it a watch!