These are step-by-step instructions on how to submit your superbill to insurance for reimbursement. This is for informational purposes only. We are unable to tell you what your insurance coverage will be.
- Call your insurance company to see what your coverage is for in-home lactation services, if there are any "in-network" providers near you and what forms they require for reimbursement prior to your appointment.
- Your IBCLC will give your a receipt/superbill at the end of the consult which will contain the following pertinent information:
- A code for the type of appointment (Procedure code/CPT code)
- A code for the problem/reason for being seen (Diagnosis code/ICD-10 code)
- Amount paid
- Date of service
- IBCLC contact information, pertinent professional/business information and a signature
- NPI number
- You will then mail, fax, scan/upload the superbill, along with your policy information, to your insurance company per their specifications. You can send a fax online for free using a service like HelloFax or sRfax once you've uploaded the document to your phone or computer.
- If your claim is denied, there may be a few reasons:
- OB/Pediatrician referral is needed.
- Missing information or more information is needed by the insurance company.
- Submitted under the wrong name.
- If you are told that you must see a provider that is in-network, ask your insurance company for a list of in-network providers. If they do not, or can not, provide a list of in-network IBCLCs, you may consider appealing your claim.
- A lot of this is still new for insurance companies, and they may be unfamiliar with the IBCLC credential. They may ask for licensure information of the provider. IBCLCs are board certified, not state licensed (as of 2016, only 2 states provides licensure for IBCLCs). Because I am also a Registered Nurse, I can provide my RN license, but otherwise, IBCLC licensure is non-existent in Texas at this time.
- If you appeal a claim, be sure to include the reason you sought breastfeeding support, especially when referred by a pediatrician or other healthcare provider, any information your insurance company required and failure of the insurance company to provide a list of in-network IBCLCs (if applicable). Citing sources like The Surgeon General's Call to Action to Support Breastfeeding of 2011 and the Affordable Healthcare Act can be helpful.
- Try, try again. Sometimes it takes a few times of sending it in before you will get reimbursed. Trust me, I know how busy you are and how little time you have for this kind of craziness, but you SHOULD be reimbursed for services by law.
Check out this post by Rachel O'Brien, IBCLC for even more information.