Payment and Insurance QuestionsMany of the families we see have questions about payment and insurance reimbursement. Here are a few of the most commonly asked questions and additional information about our practice’s payment policies.

What payment methods are accepted?

Currently, we accept all major credit cards, HSA cards, cash, check or PayPal. Payment is due at the time of service (unless you are insured through Aetna OR you have contacted your insurance provider and have received pre-authorization for out-of-network services rendered by Lactation Consultants of Central FL).

 

Does Lactation Consultants of Central FL accept insurance?

Lactation Consultants of Central FL is proud to be an in-network provider with Aetna and is working on relationships with other insurance companies. If you are insured through Aetna no payment is due and services will be covered at 100% – no prior authorization is necessary.

If you are insured by an insurance company other than Aetna (e.g. Blue Cross Blue Shield, United Healthcare, Cigna, Humana, etc.) payment will be due at the conclusion of your lactation visit. We will then file a claim on your behalf with your insurance provider. If your insurance policy covers the cost of our services, you will be refunded up to the total amount paid less any applicable deductible, co-pay, or co-insurance.

 

Am I guaranteed reimbursement for lactation visits or breastfeeding classes from my insurance company?

We cannot guarantee reimbursement from any insurance company. It’s always smart to call your insurance company for the most up-to-date information and to find out what lactation services may be covered under your health plan. Some insurance companies only cover breastfeeding education and support provided by in-network providers. Other insurance companies may cover lactation services from out-of-network providers in instances where the insurance company does not have a provider within a certain amount of miles (typically 30) for a service that they are required to cover. (Be sure to ask your insurance company if they have any in-network providers in your area. And if not, whether they will cover lactation visits with an out-of-network provider such as Lactation Consultants of Central FL.) 

Insurance companies are required to cover lactation consultations under the Affordable Care Act (ACA). A “gap exception” can help facilitate your full reimbursement when going to an out-of-network provider like Lactation Consultants of Central FL. Plans that do not have in-network providers available to you MUST cover out-of-network providers as though they were in-network (Q3).

While insurance companies are required to provide lactation services under the ACA, many require “precertification” “prior-authorization” or “preauthorization” or a referral from a physician. If reimbursement is important to you, we recommend you call your insurance company prior to your appointment to determine your coverage for in-home lactation visits or prenatal breastfeeding education classes and consultations. BEFORE calling insurance, we also recommend you thoroughly review this toolkit from the National Women’s Law Center to understand what the law requires your insurance company to cover and how. Sometimes we find that insurance company representatives are not fully aware of ACA’s provisions regarding breastfeeding support. If the representative you speak to initially denies coverage, ask to speak to another representative or supervisor who is more knowledgeable about your right to breastfeeding support from a qualified provider.

Some of our clients have shared that their insurance company approved as many as 6 in-home visits with Lactation Consultants of Central FL with no out-of-pocket deductible or co-pay. These insurance companies include:

Aetna
Humana
United Healthcare

What is “precertification,” “prior-authorization,” or “preauthorization,” and how do I get it?

Preauthorization is the process of getting approval from your health plan before you have any health procedures performed. This is usually needed for home health care services such as in-home lactation visits.

To secure preauthorization, you will just need to call your insurance company (the number is on the back of your member ID card), 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 when seeking reimbursement for lactation visits:

Our Company Name: Lactation Consultants of Central FL, LLC

Our Address: 1300 Golf Point Loop, Apopka, FL 32712

Our Phone Number: 407-595-5054

Our Federal Tax ID: 47-4752682

Our Billing NPI: 1528420379

Our Procedural Codes for in-home lactation visits: 99404 (place of service 12) and and S9443 (place of service 12). ICD-10 Z39.1

Our Procedural Codes for individual (in-home) prenatal breastfeeding education classes: S9443 (place of service 12). ICD-10 Z39.1

Our Procedural Codes for group prenatal breastfeeding education classes: S9443 (place of service 11). ICD-10 Z39.1

 

How do I schedule an appointment?

Please view our calendar and select an available appointment or call or text us at 407-595-5054 to schedule an appointment or for more information. We offer next day appointments 7 days/week from 8am – 8pm! Additionally, we are sometimes able to work in clients the very same day. Please call or email us today at LCsofCFL@gmail.com if you have an urgent need for breastfeeding help.

We’re open nights, weekends, and holidays because we all know, BREASTFEEDING CAN’T WAIT!

Schedule Lactation Appointment - In-home Breastfeeding Help