Self-Pay Clients
I accept credit card, cash check and gift card at the end of our session. I will provide you with the Superbill so that you can submit it with your claim to your health plan provider to request for reimbursement.
The Law
I accept credit card, cash check and gift card at the end of our session. I will provide you with the Superbill so that you can submit it with your claim to your health plan provider to request for reimbursement.
The Law
- Under the new health care law, all new health insurance plans must cover certain preventive health services and screenings without cost-sharing. Breastfeeding support and supplies are one of the preventive services that plans must cover without cost sharing.
- The law requires insurance companies to cover breastfeeding supports and supplies without a co-payment or other cost-sharing. While some plans previously covered these services, many only paid a portion of the cost, while the breastfeeding parent would have to pay a co-payment or co-insurance.
- Breastfeeding support and supplies will be fully covered by insurance plans and you will not need to make a separate payment to your healthcare provider or pharmacy. However, many people face obstacles in getting their pump or lactation counseling covered at all, or covered without cost-sharing. If you're having problems, see additional resources by National Women's Law Center attached at the bottom of this page to help you.
Find out more
To increase the chances of reimbursement for lactation support services
- If you have private insurance, either through a plan you bought on your own or through your employer, call your insurance company (phone number on your insurance card) to determine if you plan is grandfathered or un-grandfathered. You can ask to access these benefits, even before you have your baby.
- If you have Medicaid, check with your Medicaid plan or the local Medicaid office to see if breastfeeding counseling and supplies are covered. You can ask to access these benefits, even before you have your baby.
To increase the chances of reimbursement for lactation support services
- Before the appointment with me, call your insurance company and ask (you can follow the sample script on the right below)
- How much money they will reimburse you for an out-of-network provider.
- What their procedure is for submitting for reimbursement.
- Whether you or your baby should be the patient.
- If they want you to be the patient, ask for the specific codes they would cover for a home visit or a virtual visit. If they ask for primary diagnosis code, it is Z39.1.
- If they want your baby to be the patient, ask for the specific codes they would cover for a home visit or a virtual visit. The primary diagnosis codes could be P92.5 or Z76.2, depending on what the issues would be. We don't know yet until our visit.
- After our visit and after you have submitted your claim, if they deny it, appeal. Call your insurance company again and ask where to send an appeal. See the attached files at the bottom of the page by the National Women's Law Center, this is a great guide for how to put together an appeal letter.
- Call National Women's Law Center at 1-866-745-5487 or email prevention@nwlc.org if you need further guidance.
- Call National Women's Law Center at 1-866-745-5487 or email prevention@nwlc.org if you need further guidance.
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| factsheet_-_benefits_for_breastfeeding_parents.pdf |
| breastfeeding_toolkit_by_national_womens_law_center.pdf |
| sample_letter-_coverage-for-lactation-consult.docx |
| sample_letter_-_no-coverage-policy.docx |
uyen@marigoldlactation.com
(510) 292-7758
Half Moon Bay, California
(510) 292-7758
Half Moon Bay, California