Filing a Claim with your Insurance

INSTRUCTIONS for PATIENTS FILING FOR REIMBURSEMENT

You are encouraged to file a claim for third party reimbursement. By filing a claim, you may receive partial or full reimbursement and you help to establish the need for reimbursement of lactation services. You may find it helpful to contact your insurance company first. Some companies have specific forms that they require you to fill out when filing a claim on your own and most companies have a filing time limit.

1. Make at least one copy of the blank form (the superbill you were given at your consultation) —before you fill out the patient information on the top. This will ensure that you have another copy in case you have to appeal, or the insurance company loses the form or if you want to re-send with different patient information. (parent vs baby) It is your responsibility to keep track of this form. Duplicates will incur a charge of $10.00.

2. Complete the upper part (Patient Information portion) of the lactation visit receipt and sign the release of information on the right side directly under the Patient Information section. Be sure that the patient matches the diagnosis code. For example, if the diagnosis is “newborn sucking problem,” the patient is the baby. Some companies will reject claims for babies and some for parents. If you’ve made another copy you can file the claim a different way.

3. Parents should mail a copy of the lactation visit receipt with any other forms their insurance company may require to their insurance company. Include a note that you don’t expect to be reimbursed for mileage or other expenses on the super bill (such as nipples shields, etc). Insurance companies often “kick out” a claim because of other fees.

4. Please be sure to keep a copy of your lactation visit receipt, claim forms, referral scripts, etc. for your records and mark on your calendar when the claim was mailed in.

5. If, after 60 days, you have not heard from your insurance company, call them to check on the status of the claim. If you have not heard anything for 60-90 days, you may want to write a letter to your insurance commissioner in your state and send a copy to the insurance company.

6. The top reasons that claims are denied are because it’s not a covered service or the lactation consultant is not a provider on your plan. If it is because the lactation consultant is not a provider on your plan, ask who the lactation consultant provider is. Most likely they will say that they do not have a lactation consultant provider on their plan. Then, you reply that you had a referral to be seen by this lactation consultant by your physician because you were experiencing such and such a problem. Tell them that the American Academy of Pediatrics recommends that all babies be breastfed for one year and that the AAP recommends mothers and babies be seen by a board certified lactation consultant when breastfeeding difficulties occur. The AAP also recommends that third party insurance reimbursement be made for lactation help.

7. The Affordable Care Act mandates insurance coverage for lactation services. This is the law. It also mandates no co-pays or deductible for lactation services. Know your rights! This post will give you more information about how to talk to your insurance company about this.

8. Don’t stop with NO from the first person you speak to. Request to speak to their supervisor. The squeaky wheel is the wheel that gets oiled. If you want reimbursement, you may have to fight for it. This is how many things that are now covered by third party insurance companies have come to be standard reimbursement.

A formal appeal may be necessary for you to get reimbursed. You will find a sample letter of appeal on my website.  There is also a link there for the Washington State Insurance Commissioner. If you have been denied reimbursement for lactation services, he wants to know about it!

Breastfeeding Twins: Getting off to a Good Start.

Tandem nursing.

Tandem nursing twin boys.

You’re expecting twins!  How exciting! After the shock wears off, you may start wondering about how you will breastfeed 2 babies!  No need to worry. With some preparation and lots of support, most mothers of twins have plenty of milk for their babies. Here are a few general tips for ensuring ample milk supply when breastfeeding twins:

  • First of all, don’t listen to anyone who says you won’t be able to do this! If you can make enough milk for one baby you can make enough for two! In fact, the research shows that mothers with twins make MORE than double the amount of milk for one baby and moms of triplets make more than triple. Yes, our bodies over-compensate. Another cool thing. Your breasts know you are carrying twins before they are born and prepare accordingly!
  • Find other moms who are breastfeeding twins and enlist their support. La Leche League may be a good resource to connect with moms of multiples. Many communities have support groups for families with multiples. In Seattle, it’s Seattle Families of Multiples. Get connected while you are pregnant!
  • It would be a good idea to meet with a Board Certified Lactation Consultant (IBCLC) while you’re still pregnant. Especially true if this will be your first experience breastfeeding. She will help you find resources, locate the best breast pump and help you develop a plan for success.
  • Read books about breastfeeding—general books as well as books about twins. One of my favorite twin resources is “Mothering Multiples” by Karen Gromada.
  • Plan on renting a hospital grade pump to use until your milk supply is established. If the babies are born early, or one or both have trouble breastfeeding at first, you will have a machine that can act as a substitute for your babies. Pump as often as your babies eat! Of course, if your babies are both nursing well from birth, you will have no need for a pump. Remember if only one twin is nursing well, you will still need to pump to simulate 2 babies at the breast!
  • Research shows (as well as the experience of my clients) pumping 8x a day will yield the same amount of milk as pumping every 3 hours. So if babies can’t breastfeed yet, give yourself a break and sleep for 4 hours in a row at night. You can pump more often during the day to get in those 8 pumpings!
  • Hire an experienced, trusted lactation consultant (IBCLC) as soon as possible after the babies are born. It’s very important to get things off to a good start. Expect the LC to be supportive of your efforts and positive about your desire to exclusively breastfeed. I recommend asking her about her experience/philosophy before you meet with her. Your local twins group may have some recommendations.
  • Plan on doing nothing but feeding babies, feeding yourself and sleeping for the first 3-6 weeks. (Longer if the babies are premature) You will need help for meals, laundry, cleaning and errands. Let your wonderful helpers do everything non-baby. Your babies need you! Everything will feel much easier and you’ll be able to cope well if you take good care of yourself. Hiring a postpartum doula who is experienced with twins is a great investment!
  • If you’re having trouble with supply or babies aren’t breastfeeding effectively, try pumping for 5-10 minutes immediately after breastfeeding them. This will help you remove any milk they left behind and tell your body to make more milk.
  • Breastfeed simultaneously as much as you can. This tells your body definitively that you have twins and you need to make a lot of milk NOW.
  • Familiarize yourself with lactogenic foods. Milkmakers are one delicious way to help your supply. Foods that are rich in calcium and iron are also supportive. There are a variety of herbs and medications that can help increase your milk production, but please check with your IBCLC for advice!
  • Yes, it’s true that some mothers are not able to make enough milk for their babies. If that is your situation, you can still breastfeed. You can use donor milk or formula for supplementation when necessary.

Note: Many sets twins or triplets were conceived with the help of IVF or some other technology. If you have fertility issues, please be extra cautious the first week or so after the birth of your babies and seek help from an IBCLC immediately after birth.  Some causes of infertility are correlated with low milk supply. If you are prepared, you can avoid unnecessary newborn weight loss.

See also, “Breastfeeding Twins? Yes!”

Low Milk Supply: Could it be IGT?

Baby and mom breastfeeding with IGT

Baby and mom breastfeeding with IGT

Your breast anatomy was determined even before you were born. During the early months of fetal development, breast buds are formed. If the breast buds do not develop properly in utero, development in puberty may not occur normally. Breasts may develop minimally or not at all. And future milk making ability may be compromised. Continue reading

Baby Poop: A Story of Getting To Normal

Happy little guy!

Happy little guy!

Lactation consultants are not only interested in what goes into your baby; we’re also interested in what comes out! We like to see very frequent stooling that is yellowish in color with lots of chunky white curds. That is normal breastfed baby poop. If baby is not pooping frequently, or poop is a different color, that is not normal and we want to know why. Continue reading

The Lactation Consultation: What to Expect

This article was written in collaboration with Lyla Wolfenstein, B.S., IBCLC. Lyla is a lactation consultant in Portland, OR.

DSC9909-LA thorough lactation evaluation will probably be different than any other health-related visit you’ve experienced. It is time intensive, multi-dimensional, intuitive, experiential and often includes a bit of detective work. The International Board Certified Lactation Consultant (IBCLC) is the only health care professional that has the expertise and training required to perform such a specialized evaluation.

She (Lyla) is patient with new moms and has an ability to detect problems. She has creative solutions and never gives up on a client.

Continue reading