Does The Breastfeeding Center accept insurance?
Yes. We currently are able to accept most Aetna and United insurance plans for visits with one of our lactation consultants. Please understand that the travel fee of $100 (for home visits only) and all supplies must be paid out of pocket and cannot be billed to your insurance. Office Visits for Aetna are fully covered, with no additional fee or copay for the first 6 appointments. For United, we suggest giving them a call to see how your particular plan is covered. Certain plans may require a co-pay after your visit or require a referral.
What if I don’t have Aetna or United?
If reimbursement is important to you, then we STRONGLY suggest you call your insurance company. Please thoroughly review this toolkit from the National Women’s Law Center and this FAQ from the U.S. Dept. of Labor on Lactation Coverage under the ACA to understand what the law requires your insurance company to cover, and how, before you call them. Sometimes we find that insurance company representatives are not fully aware of ACA’s provisions regarding breastfeeding care.
Under the Affordable Care Act, lactation consultations are required to be covered fully and with no “cost sharing”(except for the very few “grandfathered plans”)—meaning that you should not have to share the cost of your consult with your insurance company. They should cover it fully. However, no insurance company but Aetna and United is currently allowing lactation consultants (IBCLCs) into their network, which is why we cannot accept your insurance directly. Plans that do not have in-network providers available to you must cover out-of-network providers as though they were in-network.
For clients for whom we are out-of-network, the cost of an prenatal office visit is $90, a postnatal office visit is $180 and the cost of a home visit is $280 ($180 for the consultation and a $100 travel fee) out of pocket.
I have an appointment scheduled. Should I call my insurance company before my appointment?
If reimbursement is important to you, then we STRONGLY suggest you call them. Just call the phone number on the back of your insurance card and have your insurance ID number ready. Some plans will require a pre-certification or gap exception. Please review the NWLC Toolkit on breastfeeding care, and DOL FAQs to understand what the law requires your insurance company to cover.
We suggest that you ASK your insurance company for a list of in-network providers for lactation consultation, if cost is a concern and they are able to provide you with an in-network option you should consider that first. However, most will not be able to provide you with a list of any in-network options for lactation care. Again, if they do not have in-network providers, the law requires them to cover out-of-network providers fully.
What is a pre-certification and how do I get it?
A pre-certification is the process of getting approval from your health plan before you have any health procedures performed. Getting pre-certification for certain procedures helps you and your provider know what is covered by your health plan before any services are performed. For lactation consultations, it also often means a higher rate of reimbursement from your insurance company.
To get a pre-certification, you will just need to call your insurance company, tell them you have an appointment scheduled with us, and check to see what information they need.
Some of our clients have found this information helpful:
Our Address: 1020 19th St NW, Suite 150, Washington, DC 20036
Our Tax ID: 522128320
Our Billing NPI: 1124237078
What is a gap exception and how do I get it?
A gap exception is something you can request from your insurance company when your insurance company does not have a provider within a certain amount of miles (typically 30) for a service that they are required to cover. Insurance companies are required to cover lactations consultations under the ACA. A gap exception can help facilitate your full reimbursement when going to an out-of-network provider like the Breastfeeding Center.
To get a gap exception, you will just need to call your insurance company, tell them you have an appointment scheduled with us, and check to see what information they need.
Some of our clients have found this information helpful: :
Our Address:1020 19th St NW, Suite 150, Washington, DC 20036
Our Tax ID: 522128320
Our Billing NPI: 1124237078
Some plans may also require the gap exception to be called in by an in-network, referring provider, such as your OBGYN, midwife or PCP.
How do I schedule an appointment?
Please call us at 202-293-5182 to schedule an appointment or for more information.
We cannot guarantee reimbursement from any insurance company. Please always call your insurance company for the most up-to-date information.