We know that having a new baby can be all encompassing and time consuming - the last thing you may want to do is fight with your insurance company to receive reimbursement for our visit. We wanted to offer just a bit of insight we've learned from other clients.
According to the AFFORDABLE CARE ACT (ObamaCare), insurance companies are required by law to cover Preventive Care Services. There are some exceptions but basically, lactation support is LEGALLY a preventive care service. Unfortunately, insurance companies will often look for ways to NOT reimburse you for the out of network benefit - EVEN when they've previously told you they would cover visits.
To optimize your chances of reimbursement, Milkwell uses ONLY preventive care class codes on the superbill. This reduces the chance of any red flags for insurance to decline your claim. They will often decline it or only pay in part. They may tell you (AND US!) that our NPI, EIN or license number is wrong and that they cannot process the claim until we verify this info. We assure you that the info on the superbill is up to date and is autogenerated so there is no chance of data entry error. YOUR decision then is to accept that partial payment or "fight them" to try to get more. If you decide to fight for your money, here is what you do:
Call your insurance company Member Services and ask to have this issue escalated to the highest representative possible. Once you get that person on the phone and give them all the info they request for your claim, if they begin the process of denying you until further information is received then you say this:
"According to federal law you are in violation of the Affordable Care Act and its protections for my family to receive preventive care services. I expect (insert insurance company name here) to adhere to federal law and reimburse me in full for the preventive care I received by this provider. Lactation is a preventive care service because it supports families by providing education and counseling on the life spectrum health benefits to continued breastfeeding. Failure to pay my claim will result in me contacting the NJ Insurance Commissioner and reporting (insert insurance company name here) for violation of federal law."
At this point, clients will begin to see action. If you do not, PLEASE report them to the Insurance Commissioner because what helps you may help another family in your shoes. https://www.state.nj.us/dobi/o...
We hope this helps you with the process. Your family has likely had a lot of medical bills during the childbearing year and we just wanted to help you get some of your money back!
warmly,
The Milkwell Team