What is a super bill and what do I do with it?

lactationcarewithelizabeth Leave a comment

What is a SUPER BILL and how do I get coverage through my insurance if I was denied through TLN or Wildflower?

First, you pay at the time of your visit for our services (you can use cash/check/card/FSA/HAS) and we can provide you with an official receipt called a “super bill” that you can use for potential reimbursement from your insurance company or medishare plan.     

This link describes what your breastfeeding coverage is under the Affordable Care Act: https://nwlc.org/resource/breastfeeding-benefits-understanding-your-coverage-under-the-affordable-care-act/

Here are things you can do and questions you can ask your insurance carrier PRIOR TO your appointment to potentially have your insurance reimburse you.  This may involve getting preauthorization.

  • What is my coverage for out-of-network Lactation services?
  • Is my provider required to be credentialed as an out-of-network provider for me to receive reimbursement? If yes, please find out exactly what they need from us, and where to fax it, and let Morgan or your IBCLC know.
  • Does my insurance exclude home visits for lactation services (location code 12)?
  • Do I have a co-payment or is there a percentage of the bill I will be responsible for?
  • Does my plan require a deductible to be paid for the calendar year before the coverage begins? If so, what is the dollar amount and how much of my deductible have I already met?
  • Does my insurance plan only cover a limited number of sessions for each calendar year?
  • Is there a fax number I can use to submit superbills? If not, what address should be used?  * When submitting superbills to insurance please be sure to specify that you would like direct reimbursement.
  • Is there an additional form to be submitted with superbills?
  • If your insurance carrier has no in-network lactation consultant (IBCLC) that provides private lactation consults, you can petition that they pre-authorize us as an in-network providers. You can try to get a pre-authorization for your consults, but you must do this beforehand by requesting a “gap exception” or an “in-for-out”. Request that this be expedited. Write everything down — who you spoke with, case number and the authorization number. Ask that you be sent confirmation in writing. (Even with a pre-authorization, you will still pay up-front and request reimbursement from your insurance company.)
  • The typical procedure codes we use are s9443 or 99404,  so find out which is acceptable, or if there are other codes they would like us to use. The diagnosis code used is z39.1 (Maternal Lactation Care).
  • Practitioner information you might need when you call your insurance:
    •  Business name: Lactation Care with Elizabeth. 
    • Company NPI: 1881291144
    • Company EIN: 81-2896336

ANNOUNCEMENT: SIGNIFICANT CHANGES IN COVERAGE THROUGH THE LACTATION NETWORK (TLN)

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Hello, sweet families.

A few years ago we made the decision to move from a self pay practice to participating with The Lactation Network (TLN), and later Wildflower, to provide a way for insurance coverage for lactation visits.  This week TLN sent an email to the IBCLCs contracted with them and announced, with no prior warning, that they were creating visit limits, effective immediately for new clients and after May 16 for current clients.  If you are a current client that is affected, you should have received an email from TLN.  

Who this affects:

-if you have Anthem/BCBS and are new with us starting May 1, we have 6 visits that are covered through TLN and then we can move to self pay, per the TLN email.

-if you have Anthem/BCBS and have already used more than 6 visits, PLEASE SCHEDULE BEFORE MAY 17, TLN states in their email that they will continue to cover these visits.  After May 17, if you are over the 6 visit limit, we will move to self pay.  

-if you have BCBS and haven’t used your 6 visits, we will keep a count of your visits and move to self pay after 6 visits as needed. 

Who this shouldn’t affect:

– If you have Cigna (paid through Wildflower), you will continue to have 5 visits covered, and we can request additional visits as needed if we have justification for those visits.

-if you have United (paid through TLN), it doesn’t look like there is any change currently, and we will continue as we have been.

-if you are already self pay, we will continue on as usual.  

For self pay visits, we can provide a superbill/receipt with codes that you can submit directly to your insurance company for potential reimbursement.  HSA/FSA cards are a useful way to pay as well.  

What else can we do?  You can contact your HR department and your insurance company and request consideration for unlimited lactation support.  We will continue to work on ways to provide you and your family with the lactation support you need and deserve. 

Here is the direct link to schedule a visit https://lactationcarewithelizabeth.janeapp.com/

Please reach out with any questions!  We have opened up as much availability as we can over the next few weeks to accommodate as many families as possible; if you don’t see an opening, please reach out and we will do everything possible to make sure you are seen.

CST – craniosacral therapy

morganlce Leave a comment

Elizabeth has trained with Upledger, Peirsman, and Beames for infant and adult Cranial Sacral Therapy (CST). CST helps to reduce tension and strain patterns through listening to and working with the cranial sacral rhythm. Current & past mom clients & babies can rest on the table for gentle releases of tension deep within the body. CST may help reduce pain, relieve dysfunction & improve whole body health. Can be scheduled back to back with lactation consultation appointment, as well. Schedule online here for craniosacral therapy at our office in Lexington, KY.