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