FAQ

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

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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

Update on Insurance Companies Covering Care

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We currently partner with The Lactation Network in order to be considered an in-network provider for many of our clients. Through our partnership, we are able to provide care to many at no personal cost to them. Many insurance companies are covering lactation services: prenatal visits, office visits, telehealth visits and home visits.

Effective immediately, Cigna is NOT providing coverage for the items in partnership with The Lactation Network. They have partnered with them in the past, but were unable to come to an agreement and can no longer cover Cigna customers.

The Lactation Network should be contacting you if you have Cigna and are an active client with Lactation Care with Elizabeth. If you have Cigna and saw us in the past, this will mean your care won’t be covered via The Lactation Network.

As always, if you haven’t had a visit in 6 months or more, you will need to resubmit your insurance information anyway to be sure there have been no changes to your coverage. This is available via our scheduling page online, but more efficient would be through your account with The Lactation Network.

The Lactation Network partnership has made no-cost care available to many. We do also provide self-pay services. If cost is a concern, please contact us to discuss options.

If you have any questions, please call Morgan at 859-832-0203 or email morgan@lactationcarewithelizabeth.com.

Real Client, Real Experience

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Received from a current client as of January 2022:

“I’ve been so thrilled with my experience 
with Elizabeth (and Katie) I would be glad to sing their praises any time!

Going in, I thought a lactation consultant would just show you how to 
hold the baby properly and ensure a good latch, I didn’t know enough to 
even realize there could be more to learn. We’ve gotten so much more 
than that; Elizabeth has been so compassionate and encouraging; in 
talking over our problems, we always feel she’s part therapist for us, lol.

We didn’t realize that appointments would include before and after weigh 
ins for the baby, which has been such a reassurance. When breastfeeding, 
it’s kind of hair raising to not know how much food your baby is 
actually getting. Having that info was such a relief.

Having someone inspect his mouth, gauge the strength of his suck, and 
tongue action, etc, was something I didn’t realize could even be 
examined, and knowing that he doesn’t have any problems in those 
departments was also a relief; I’d say the same if she DID find 
problems, knowing is half the battle, after all.

She’s helped put to bed many of our anxieties about handwashing, green 
diapers, spit up, and some medical misconceptions (I had been worried 
that letting him comfort nurse would stimulate my body to keep producing 
more milk, but she explained that it’s a different sucking pattern and 
my body knows to ignore that in terms of milk production). Elizabeth has 
also given my husband pointers for bottle feeding, and advice on different 
nipple styles, and even a new nipple to test drive at home. In my mind, 
I thought a lactation consultant would cover breastfeeding alone; if we 
had gone with formula or exclusive bottle feeding of breastmilk, we 
never would have even thought about seeking out a lactation consultant. 
I imagine there are others like that too, who think this type of service 
is for the breast-fed baby alone.

Sometimes just watching how Elizabeth handles the baby has been so 
helpful too. Perhaps like many first time parents, we’ve been handling 
him like glass, so to see someone handle him more freely and confidently 
helped us realize he’s stronger than we think, and we have more freedom 
in how we hold him too. She’s also taught us new ways to hold him, and 
burp him, that have brought us a lot of success compared to the standard 
techniques we were shown in the hospital. She’s also given us ways to 
help strengthen his tongue function, like tracing our finger around his 
gums, and sweeping around on his soft palate and pushing down on his tongue.

Connecting with Katie has also been wonderful; we wouldn’t have even 
been aware such services existed if we hadn’t met her by chance at our 
first appointment with Elizabeth. In the same way, Katie handles the 
baby so confidently and effortlessly that we’re reminded we can handle 
him more freely too. And many of the exercises she has done with him are 
things we’ve been able to replicate at home as well (some different 
stretches, nothing with his skull, haha). He enjoys all the new touches!

Perhaps we’re just particularly hungry for confident 
familial energy to help guide us through this time and both Elizabeth 
and Katie have that kind of warmth and positivity. We’ll be sad when 
Emmery stops breastfeeding and we no longer have an excuse to go.”

WE couldn’t ask for a better overview that touches on some (still not all) aspects of lactation support as practiced at Lactation Care with Elizabeth. A wholistic, family approach includes much more than a latch. And seeking help from an IBCLC affords expert advice on many aspects of lactation, feeding, structure and development.

Within the safe space of lactation support, processing and healing occur, both mental and physical. We are thankful for other professionals we include in our care for clients and love to hear about the progress made outside of our office. Thanks to our client for the kind words and personal examples of her experience with breastfeeding support!

What happens during a Lactation Consulting visit?

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I love helping moms and babies work through issues in their breastfeeding relationship! A consult happens in a lovely, peaceful environment where we can spend time answering all your questions as well as caring for YOU, the new mom, as a person, and loving on your sweet baby.

We will first meet 30-60 minutes virtually, where we will go over the intake you have filled out, and we will talk about your health, your birth, and your baby’s health. Next, we discuss what you are currently doing for feedings, struggles you are having, and I may talk you through an oral exam, watch your baby feed, and check your pump flange size (depending on time.)

Next, we will schedule and office visit (or may continue with virtual visits, depending on need.)  We are currently doing temperature checks, asking covid questions, and requiring everyone to wear masks. Please feel free to bring one support person, but no other children. We are doing cleaning and changing scrubs between appointments to provide as safe and clean an environment as we can.  If you are ill, please reschedule or change to a virtual appointment!

An office visit is 60 minutes.  We will review changes since our last appointment. Then, before the baby feeds, I assess the baby’s mouth and suck, weight, and assess the breasts. During the feeding, we will address problems and work together to find solutions to meet your breastfeeding goals. After the feeding we will do another weight to see how much baby transferred.  Then we will come up with a plan.  My goal is that you will leave with a workable plan and confidence to move forward! We will schedule follow up visits or phone calls as you need them.

What is an IBCLC?

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What is an IBCLC? How are IBCLCs different from other Lactation Consultants?

IBCLC stands for International Board Certified Lactation Consultant. This is the gold standard for lactation consultants. To acquire this certification, I spent a lot of time (1000 hours) working under experienced IBCLCs, took 75 hours of courses in human lactation, and then studied for and passed the IBCLC exam. I initially took and passed the exam in 2011. Every five years, an IBCLC has to recertify; I recertified in 2016 with 75 hours of continuing lactation education.

What makes an IBCLC different from other lactation consultants? A Certified Lactation Counselor, or CLC, has taken a short (usually 40 hours) class and passed a written test; there is no required hands on component. Don’t misunderstand: there are many experienced Lactation Counselors out there who can offer valuable assistance! But do ask what kind of experience the person you are seeing has. You want someone helping you who has both book knowledge and supervised hands on experience.

I was a CLC on my journey to becoming an IBCLC. I currently have more than 16 years of experience caring for breastfeeding mothers, along with my certifications. I would love to work with you and your baby to help you reach your breastfeeding goals.

 

Find out more about how to become an IBCLC from IBLCE.