FAQs Regarding Insurance and Payment for Lactation Services

Many 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, health savings account (HSA) cards and flexible spending account (FSA) cards.

Does Lactation Consultants of Central FL accept insurance?

We accept all: United Healthcare, UMR, Golden Rule commercial plans, Cigna and most Blue Cross Blue Shield (BCBS) and Florida Blue PPO plans.

To check your eligibility for free lactation visits click here (non-Cigna) or click here if you have Cigna.

If you are insured by another health plan or do not qualify for free lactation visits, payment is due at the conclusion of your lactation visit. To help with insurance reimbursement you will be provided with a Superbill (upon request) which you can send along with your claim to your insurance provider for possible reimbursement.

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.

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 are wanting to schedule an appointment with us, and check to see what information they need.

Some of our clients have found this information helpful when seeking pre-authorization/reimbursement for lactation visits:

Company Name/Billing Provider Name: Lactation Consultants of Central FL, LLC

Billing Provider NPI (Organization/Group): 1669037826

Address: 1300 Golf Point Loop, Apopka, FL 32712

Phone Number: 407-595-5054

Fax Number: 407-386-6161

Federal Tax ID: 47-4752682

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

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

We are unable to communicate with your insurance provider on your behalf. If you have filed a claim with your insurance provider for reimbursement, you can check your claim status, by visiting your insurance plan’s member portal. 

How do I schedule an appointment?