Out Of Network Reimbursement

If we have sent you this post, Growing Families is not in-network with your health insurance plan. Some health insurance carriers do not offer to pay private practice lactation consultants directly. The benefit of using a private practice lactation consultant like Growing Families is that you have text / phone support between visits and the visit occurs in your home. All health insurace plans have to offer some kind of coverage for lactation - but your only free/insurace covered option could be in a hospital or office setting without phone / text support after your appointment.

If you would like to have in-home support with Growing Families, we do have self-pay rates. These rate is $160 for a prenatal visit or a postpatum lactation visit with your baby in your home.

Superbill (do this if baby has already arrived and you need a lactation visit ASAP):

Some insurance compaines will reiburse for these services when you submit a superbill / reciept. Growing Families provides the superbill / reciept. This means that you would pay Growing Families in full (cash / check / card) and then you would request reimbursment from your insurance company. Submitting a superbill does not gurantee that they will reimburse you in full, in part, or at all. However, it's especially worth exploring if you are pregnant and want to prepare in advance. It's also worth submitting if you've already had a lactation visit in your home and you want to try to get reimbursed. You can call your insurance company and tell them the following:

"I would like to have in-home lactation support with IBCLC, Jessica Bower. She is not an in-network provider with my plan. I would like to know if you will reimburse me in part or in full for her services. The codes she will use are:

For all plans except Aenta:

Procedure codes: 99404

Diagnosis code: Z 39.1

Total fee is $160

She will provide me with a superbill that will include the following:

Her NPI - 1962173260

Her EIN - 88-2805818

Her IBCLC Certification Number - L-307605

Patient's name and date of service

Total charges

See what your insurace company says when you call with that information. If they tell you that they will reimburse you, be sure to get a reference number for your phone call. You can also ask them about this over a portal where you can take pictures or save this information. Additionally, be sure to ask about how and where you would submit your superbill. It will likely be through a portal with them. Your Superbill will come from Growing Families via email and it will be a PDF. Many plans will reimburse in part or in full in our experience. You do just have to do some work to figure out how to get reimbursed.

GAP Execption Requests (To do in advance in pregnancy):

A gap ecxpetion (also referred to as a netowrok deficiency, gap waiver, or "in-for-out") is a request for the insurance company to cover a patient's services as in-network, even though they are receiving services from an out-of-network provider. In other words, it is a request to fill the "gap" they have in their own network by not having any in-network lactation consultants who do home visits. Request that your insurance company cover numerous visits - at least 6 - because we often need follow-up visits to continue to improve feeding outcomes. Your insurance company will need you to complete a form and include the following information:

From your referring in-network provider (your OBYGN / Midwife), you will need:

• A letter of medical necessity with appropriate diagnostic codes

• Perscription (referral for lactation services)

• Clinical notes / visit history (this would include history of a prior challenging breastfeeding journey or the desire to breastfeed and needing support in place in advance)

From Growing Families Lactation & Doula:

• Address: Growing Families Lactation & Doula / 4311 Strader Farm Trail / Julian NC 27283

• Phone: 336-707-3842

• Tax ID / EIN: 88-2805818

• NPI: 1962173260

• Diagnosis code: Z39.1

• CPT codes:S9443, 99404

We are in-netowrk and use billing companies for many insurance plans - but if we've sent you this post, it means that we are not in-network with your specific plan and that the superbill / reimbursement / gap exception route is the only want to proceed if you'd like in home support and would like help paying for it. We hope this information is helpful!