insurance

 

 

What Does My Insurance Cover?

“Just Natural” feels very strongly that effective Lactation Services should be covered by insurance companies  just like any other health care service.   Breastfeeding is at the very core of preventative care.  The Affordable Health Care Act mandates lactation services & supplies will be covered by insurance benefits.  Most insurance companies state they cover lactation services.  Although most insurance companies do not have the Lactation Consultant provider type in network, recently though, many more are now contracting them.   We are now in net-work with Aetna PPO plans, Meritian, Prime Health Care, Tricare and United Health Care, and there will be no out of pocket cost for you other than a courtesy fee for home visits.   In very minimal cases a co-pay may apply depending on the plan.

     The ACHA law states that breastfeeding services and supplies will be provided as a preventative benefit making this service not subject to co-pays, co-insurance or out of pocket costs.   However, when the service is provided out-of- network, preventive services are either not covered or subject to co-pay, co-insurance and out of pocket maximums.  This mostly happens with PPO plans that do not have a lactation consutlant in network.   HMO plans that do not have a lactation consultant in network will not pay for lactation services without a gap exception.

   We can work with PPO insurance plans out of network.   At this time Blue Cross, Blue Shield and Cigna do not allow Board Certified Lactation Consultants in-network in California.   However, in many cases some of the plans will pay an out-of-network provider the same as if in network.  We can check your benefits for coverage.  See below how to schedule a consultation.

   We recommend you check with your insurance company to inquire about your coverage.  In some cases the insurance company can give you a referral to an IBCLC  in network or that can bill your insurance in your area.  If they refer you to a free clinic with limited resources and availability then they are not full filling their obligation under the Affordable Health Care Act.  

You can use your health care spending account to pay for our lactation services.  We are fully qualified health care providers.

“Gap Exception” Since the affordable care act requires insurance companies to provide lactation services, but does not have an IBCLC in net-work, you can call and ask for a exception for the IBCLC you choose.   You will need to abtain the IBCLC’s Tax ID #, NPI #, and common billing codes used.  If the IBCLC does not have these numbers, she/he will not be able to help you abtain a gap exception.  You will then need to call for approval from your insurance company 30 to 45 days in advance for approval.   This is a great option for any mom who is proactive and looking for her own lactation consultant prior to the baby’s birth.   “Just Natural” meets  the qualifications to bill insurance and is willing to help you with this process.  In some cases, with persistence (by Just Natural), approval can be achieved in days and retroactive.  We can help you with a gap exception.

We can help you determine if your benefits will cover breastfeeding services or achieve a gap exception. Please schedule a free Telephone Advice Consultation service. Use coupon code FREEINFO when booking to get this service for free.  

The cash pricing for our services  listed,  is a prompt pay discount price.  This means the prices reflect a significant discount if services are paid for at the time of booking the appointment.   Otherwise our prices resemble what would be billed to an insurance company.

What Does My Insurance Cover?

“Just Natural” feels very strongly that effective Lactation Services should be covered by insurance companies  just like any other health care service.   Breastfeeding is at the very core of preventative care.  The Affordable Health Care Act mandates lactation services & supplies will be covered by insurance benefits.  Most insurance companies state they cover lactation services.  Although most insurance companies do not have the Lactation Consultant provider type in network, recently though, many more are now contracting them.   We are now in net-work with Aetna PPO plans, Meritian, Prime Health Care, Tricare and United Health Care, and there will be no out of pocket cost for you other than a courtesy fee for home visits.   In very minimal cases a co-pay may apply depending on the plan.

     The ACHA law states that breastfeeding services and supplies will be provided as a preventative benefit making this service not subject to co-pays, co-insurance or out of pocket costs.   However, when the service is provided out-of- network, preventive services are either not covered or subject to co-pay, co-insurance and out of pocket maximums.  This mostly happens with PPO plans that do not have a lactation consutlant in network.   HMO plans that do not have a lactation consultant in network will not pay for lactation services without a gap exception.

   We can work with PPO insurance plans out of network.   At this time Blue Cross, Blue Shield and Cigna do not allow Board Certified Lactation Consultants in-network in California.   However, in many cases some of the plans will pay an out-of-network provider the same as if in network.  We can check your benefits for coverage.  See below how to schedule a consultation.

   We recommend you check with your insurance company to inquire about your coverage.  In some cases the insurance company can give you a referral to an IBCLC  in network or that can bill your insurance in your area.  If they refer you to a free clinic with limited resources and availability then they are not full filling their obligation under the Affordable Health Care Act.  

You can use your health care spending account to pay for our lactation services.  We are fully qualified health care providers.

“Gap Exception” Since the affordable care act requires insurance companies to provide lactation services, but does not have an IBCLC in net-work, you can call and ask for a exception for the IBCLC you choose.   You will need to abtain the IBCLC’s Tax ID #, NPI #, and common billing codes used.  If the IBCLC does not have these numbers, she/he will not be able to help you abtain a gap exception.  You will then need to call for approval from your insurance company 30 to 45 days in advance for approval.   This is a great option for any mom who is proactive and looking for her own lactation consultant prior to the baby’s birth.   “Just Natural” meets  the qualifications to bill insurance and is willing to help you with this process.  In some cases, with persistence (by Just Natural), approval can be achieved in days and retroactive.  We can help you with a gap exception.

We can help you determine if your benefits will cover breastfeeding services or achieve a gap exception. Please schedule a free Telephone Advice Consultation service. Use coupon code FREEINFO when booking to get this service for free.  

The cash pricing for our services  listed,  is a prompt pay discount price.  This means the prices reflect a significant discount if services are paid for at the time of booking the appointment.   Otherwise our prices resemble what would be billed to an insurance company.

Insurances we work with

 

  • In-network:
  • Aetna PPO & POS, Meritain,  Prime Health Care, Tricare, & United Health Care
  • We can work with most PPO plans.   We can call to check you plan for breastfeeding specific coverage, and/or we can provide a super bill
  • May be able to bill HMO with a gap exception

Get In Touch

corona, CALIFORNIA
+1 951-394-2087