FAQ (Frequently Asked Questions)
Curious about how my services work? Start here!
Insurance Coverage for Outpatient Lactation Services:
Answers to some frequently asked questions about insurance coverage for Lactation visits.
Q:
Can you bill my health insurance for my Lactation Consultation?
A:
It depends. Many health insurance plans cover my services as preventive care per the Affordable Care Act. I offer insurance billing for some plans including Blue Cross & Blue Shield, Anthem, Cigna, UMR, UHC, Champ VA. Aetna, and Meritain. I am unable to offer Medicaid billing at this time. For more info, please fill out the Request a Consultation using my Health Insurance form to determine insurance billing eligibility for your specific plan. Also, please allow 24 hours for me to verify your insurance eligibility.
Q:
But my health insurance provider says Lactation Consultants are "covered" under my policy. Why can't you bill them?
A:
This is where we find a disconnect known as the "Lactation Coverage Gap." Insurance providers in the United States were federally mandated to cover the cost of Outpatient Lactation Services (both pre and postnatally) with the passage of the Affordable Care Act of 2010 for any policies that didn't already exist. However, IBCLCs (International Board Certified Lactation Consultants) are unable to become in-network providers with some health insurance organizations. Also, some categories of insurance plans (like HMOs for example) require a referral from your PCP before a Lactation Consultation would be deemed eligible for insurance coverage.
Q:
So what can I do if I don't qualify for covered visits through my insurance plan?
A:
I will bill you as a cash pay patient and provide a receipt and a coded document called a Superbill for each visit. You can contact your health insurance provider to ask how you can submit these documents and request reimbursement for an out-of-network claim. PLEASE NOTE THAT I CANNOT GUARANTEE REIMBURSEMENT FROM YOUR INSURER AND THAT YOU ARE RESPONSIBLE FOR CORRESPONDING DIRECTLY WITH THEM IN REGARD TO YOUR OUT-OF-NETWORK CLAIM(S).
Q:
So I called my Health Insurance provider and asked about my coverage for Lactation services. They told me to have you complete a "Gap Exception Form" so you can bill them directly for my consultations or said I can complete this form for you. Can you complete this for me?
A:
No. I am unable to communicate directly with your insurance provider and cannot complete any Gap Exception or Single Case Agreement request forms. I am happy to see you as a cash pay patient and provide a receipt and coded Superbill for each visit.
Q:
Can I use my FSA/HSA card to cover a Lactation Consultation with you?
A:
Yes! Teapot Lactation LLC can accept FSA/HSA card payments based on the category of services I offer. Please review your individual FSA/HSA plan requirements to make sure your FSA/HSA includes Lactation services when provided by an IBCLC.
Lactation Consultation Questions:
Answers to some frequently asked questions about how Consults work.
Q:
Do you offer home visits?
A:
Yes! I offer Initial Home Visits within 30 miles of my home office (essentially within the Tulsa Metro Area) with no additional fuel or mileage charges.
Q:
What if I live more than 30 miles outside of Tulsa. Can I still schedule a home visit with you?
A:
Yes, based on availability. I assess fuel and mileage charges for any home visits to locations more than 30 miles away from my office. Also, since there is additional travel time involved, long-distance home visits are subject to my availability. Please email me at tracy@teapotlactation to request a long-distance home visit appointment and mileage quote. Please note that fuel and mileage fees are not eligible for insurance reimbursement.
Q:
Can you come to the hospital and see me when I deliver?
A:
No. I am not legally able to provide service on site through Teapot Lactation. That being said, most hospitals employ a team of Lactation professionals who are there to assist you with initiating breastfeeding while you are inpatient. If you deliver in a facility that does not employ a Lactation Consultant, I am happy to arrange a virtual visit with you (if needed) while you are inpatient.
Q:
Can you really provide Lactation Consultant services in a Virtual Visit?
A:
Yes! While I am not there "in person" to assess (and in-person assessment is far more accurate), I will communicate with you prior to virtual visits about any photos, videos, or other records needed for our consultation. I am proud to provide comprehensive, personalized Lactation Consultations via secure, encrypted videocall.
What happens at a Lactation Consultation?
Answers to some frequently asked questions about what happens at a Lactation Consultation.
Q:
So....what actually happens at a Prenatal Lactation Consultation?
A:
Prenatal Lactation Consultations are a PERFECT opportunity for moms-to-be to become better prepared to begin breastfeeding and meet their goals! Prenatal Visits last for about an hour, and include breast exam/flange sizing, education about breastfeeding in the first few days of baby's life, discussion about any risk factors in your history that could affect breastfeeding. I'll also show you how your breast pump works (if you have it on hand) or provide some guidance on how to choose the right breast pump for YOU.
Q:
What about my Initial Lactation Consultation? Why does it take 90 minutes? How is this different from the Follow-up Visits?
A:
Initial Lactation Consultations (whether In-Person or Virtual) take at least 90 minutes because a lot happens during these first visits. For In-Person visits, I perform a weighted feeding assessment to see if baby is getting enough to eat during breastfeeding. I also assess mom's breasts, perform a pumping assessment, and perform an advanced oral exam on baby. For Virtual Visits, I perform feeding, breast, and pumping assessments, and I provide instructions on how to obtain a weighted feed check. I will also communicate prior to virtual visits about any photos of videos needed for me to assess baby's mouth. Once all assessments are complete, I'll work with you to create a customized plan of care to help move you closer to your feeding goals.
Based on your plan of care, I'll recommend when we set up Follow-up Consultations. These visits are shorter, lasting about 60 minutes, and typically include a feeding assessment and follow-up exams as indicated. Basically, I'm checking your progress and adjusting the plan of care accordingly.
Q:
What about the 30-Minute Problem Visits? How are those different?
A:
30-Minute Problem Visits are short visits intended for addressing one specific issue pertaining to the breastfeeding parent. These visits are available virtually, and are designed for addressing issues like low milk supply, problems with pumping, questions about weaning, or blocked ducts. Problem visits DO NOT include a weighted feeding assessment or advanced oral exam and are not intended for evaluation of potential TOTs (tethered oral tissues).