Your Insurance Owes You Reimbursement for Preventative Health Care
Bay Area Breastfeeding Support
5425 Martis Court
El Sobrante, Ca 94803
Serena Meyer, RN, IBCLC
IBCLC-reg. L-22769 RN- CAL reg. 95048954
NPI # 1306113881 EIN # 45-3915267
[email protected]
Office (925) 257-4023 MSG only
Fax (510) 275-0331
Need to ask your insurance about the coding they cover? Here you go!
The diagnostic code is "Care of a lactating woman": Z39.1
I use all of the following codes, each visit:
Initial Lactation consult: S9443, 99204, 99404
I am in-network with Hill Physicians which means depending on your deductible and co-pay, my fees should be covered. I am in-network with Aetna, but not the Google funded program unfortunately.
Travel fees: Insurance will not cover incurred travel fees.
Google Anthem employees are 100% covered with unlimited visits providing they have Anthem. I am not in-network but understand the coding required for you to be reimbursed.
I can offer a superbill for insurance reimbursement for insurance companies, or a receipt for HSA of FSA . If you pay by HSA or FSA you get a receipt but not a superbill!
Depending on your insurance company the range for reimbursement is as follows: Medi-cal ( will not cover), CIGNA (unlikely unless you elected to get the highest level of coverage), and Kaiser will not reimburse anything at all even if they tell you they will.
United and HealthNet will reimburse certain codes but most of them have to be coded by an MD, so if you work in private practice they will not cover the whole fee, most of the time they currently don't cover visits.
It is your job to ask Anthem BCBS for a gap extension for preventative health services (as Lactation Care is classified). Remember that denial is par for the course with insurance companies and that you'll have to be clear with them that they are in violation if they cannot offer you a in-network provider within 30 miles. The key is that they will tell you that they only cover in-network providers but then they cannot offer you any in the Bay Area, which means they are in violation of CA insurance law.
Why do Insurance Companies deny coverage? Because they can. You will have to assertively voice that you know they must cover services in order for them to agree to pay you back.
Here are five PDFs to read over before you call to argue with them: California Network Adequacy and HMO Network Adequacy. Make sure you read this too: State of Breastfeeding Coverage: Health Plan Violations of the Affordable Care Act This last one is scary to them and if you use some of the language they will know they can't get away with it. Also this read this doc over, Benefits for Breastfeeding Moms: Understanding Health Coverage of Breastfeeding Support and Supplies.
When you talk to a person on the phone make sure you sound confident, and if you are told that they have no in-network providers and they won't cover out of network services, consider saying something like: "I'll be consulting with the national women's law center to file a complaint and law suit if we fail to come to a resolution on this important, time sensitive health need."
Also look on my blog for a step by step way to coax Anthem to give you gap coverage.
5425 Martis Court
El Sobrante, Ca 94803
Serena Meyer, RN, IBCLC
IBCLC-reg. L-22769 RN- CAL reg. 95048954
NPI # 1306113881 EIN # 45-3915267
[email protected]
Office (925) 257-4023 MSG only
Fax (510) 275-0331
Need to ask your insurance about the coding they cover? Here you go!
The diagnostic code is "Care of a lactating woman": Z39.1
I use all of the following codes, each visit:
Initial Lactation consult: S9443, 99204, 99404
I am in-network with Hill Physicians which means depending on your deductible and co-pay, my fees should be covered. I am in-network with Aetna, but not the Google funded program unfortunately.
Travel fees: Insurance will not cover incurred travel fees.
Google Anthem employees are 100% covered with unlimited visits providing they have Anthem. I am not in-network but understand the coding required for you to be reimbursed.
I can offer a superbill for insurance reimbursement for insurance companies, or a receipt for HSA of FSA . If you pay by HSA or FSA you get a receipt but not a superbill!
Depending on your insurance company the range for reimbursement is as follows: Medi-cal ( will not cover), CIGNA (unlikely unless you elected to get the highest level of coverage), and Kaiser will not reimburse anything at all even if they tell you they will.
United and HealthNet will reimburse certain codes but most of them have to be coded by an MD, so if you work in private practice they will not cover the whole fee, most of the time they currently don't cover visits.
It is your job to ask Anthem BCBS for a gap extension for preventative health services (as Lactation Care is classified). Remember that denial is par for the course with insurance companies and that you'll have to be clear with them that they are in violation if they cannot offer you a in-network provider within 30 miles. The key is that they will tell you that they only cover in-network providers but then they cannot offer you any in the Bay Area, which means they are in violation of CA insurance law.
Why do Insurance Companies deny coverage? Because they can. You will have to assertively voice that you know they must cover services in order for them to agree to pay you back.
Here are five PDFs to read over before you call to argue with them: California Network Adequacy and HMO Network Adequacy. Make sure you read this too: State of Breastfeeding Coverage: Health Plan Violations of the Affordable Care Act This last one is scary to them and if you use some of the language they will know they can't get away with it. Also this read this doc over, Benefits for Breastfeeding Moms: Understanding Health Coverage of Breastfeeding Support and Supplies.
When you talk to a person on the phone make sure you sound confident, and if you are told that they have no in-network providers and they won't cover out of network services, consider saying something like: "I'll be consulting with the national women's law center to file a complaint and law suit if we fail to come to a resolution on this important, time sensitive health need."
Also look on my blog for a step by step way to coax Anthem to give you gap coverage.
| provider_network_adequacy.pdf |
| nwlc_breastfeedkeyfindings.pdf |
| nwlc_breastfeeding_fact_sheet.pdf |
| hmo_network_adequacy.pdf |
| anthem_tips.pdf |
