Reimbursement
The Affordable Care Act mandates that insurance companies have to cover lactation education, support, and supplies with no copay or deductible. However, insurance companies love to find loopholes and make the process inconvenient to get out of paying for the support you need and deserve. If we are not able to directly bill your insurance company, that does not mean you’re stuck with the bill. Most plans count on parents not wanting to deal with the headache of submitting. Here are some steps you can take BEFORE your appointment.
1. Ask your doctor for a prescription. It should say ‘Refer to IBCLC for feeding difficulties’. Have them write it on paper so you have a copy.
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2. Call the number on the back of your card and ask them to preauthorize visits with us, and tell them you have a prescription from your doctor. They’ll need our practice information - EIN 86-1301692 and NPI 141754635. We’re happy to provide any additional information they ask for.
3. Even if you do everything right, they may still deny the claim when you submit it. This happens OFTEN. We write an appeal letter requesting that they reverse the decision. Many times, this isn’t something your insurance is used to people trying to get covered, so it’s easier for them to deny it than actually look up what they’re required to cover.
After your appointment
HAP
You will need to submit your itemized Superbill and a completed Direct Member Reimbursement form. To access the form, log in and click on Member Resources under Quick Links. Then mail both to this address:
HAP Claims Division
Attention: Member Reimbursement
2850 West Grand Boulevard
Detroit, MI 48202
Priority Health
Complete Member Reimbursement Form. Submit one claim for you and for your baby. Fax to 616.942.0616 for quickest processing.
If unable to fax, mail to:
Priority Health
ATTN: Claims Department
P.O. Box 232
Grand Rapids, MI 49501-0232
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Blue Care Network
Pre-authorizing is usually not required, except when dealing with Blue Care Network. They are less likely to reimburse you after the visit without the pre-authorizing described above.