Breastfeeding support is considered preventative and by law is a covered, but every plan differs and you need to know your own benefits.
YOUR RIGHTS UNDER THE LAW
The National Women's Law Center has developed a toolkit called New Benefits for Breastfeeding Moms: Facts and Tools to Understand Your Coverage under the Health Care Law.
The National Women's Law Center has developed a toolkit called New Benefits for Breastfeeding Moms: Facts and Tools to Understand Your Coverage under the Health Care Law.
IN NETWORK IN NEW JERSEY?
AETNA provides in-network coverage to most plans in New Jersey with up to 6 visits, but it's up to you to know your own benefits in your plan.
AETNA provides in-network coverage to most plans in New Jersey with up to 6 visits, but it's up to you to know your own benefits in your plan.
WHAT ABOUT OUT OF NETWORK?
A coverage gap exception is a preemptive waiver from a healthcare insurance company that allows a customer to receive medical services from an out of network provider at an in network rate.
You request a coverage gap exception when you know your insurance company covers lactation benefits, but you don't believe that the insurance company has in network providers that can provide those benefits. You make a case that your insurance company cannot provide the necessary treatment.
Pre-authorization is when you request your insurance company for an in-network coverage of your benefits with an out-of-network provider.
In either case, request coverage for at least 3-6 visits because breastfeeding management can take more than one appointment and is an evolving process.
This process happens BEFORE you book an appointment.
WHAT ABOUT SELF-PAY WITH A SUPERBILL AND INSURANCE REIMBURSEMENT?
If you'd rather not try the above, you can always self-pay and use the superbill I supply to garner reimbursement.
If they deny your claim, you resubmit it. When speaking to your insurance carrier for reimbursement, have your written benefits statement handy, take note of you who speak to, escalate to a supervisor or case manager if necessary and if all else fails you can make a complaint to NJDOBI or your local state board.
There is a script for calling your insurance carrier on page 8 of the Toolkit New Benefits for Breastfeeding Moms: Facts and Tools for Understanding Your Coverage under the Health Care Law
A coverage gap exception is a preemptive waiver from a healthcare insurance company that allows a customer to receive medical services from an out of network provider at an in network rate.
You request a coverage gap exception when you know your insurance company covers lactation benefits, but you don't believe that the insurance company has in network providers that can provide those benefits. You make a case that your insurance company cannot provide the necessary treatment.
Pre-authorization is when you request your insurance company for an in-network coverage of your benefits with an out-of-network provider.
In either case, request coverage for at least 3-6 visits because breastfeeding management can take more than one appointment and is an evolving process.
This process happens BEFORE you book an appointment.
WHAT ABOUT SELF-PAY WITH A SUPERBILL AND INSURANCE REIMBURSEMENT?
If you'd rather not try the above, you can always self-pay and use the superbill I supply to garner reimbursement.
If they deny your claim, you resubmit it. When speaking to your insurance carrier for reimbursement, have your written benefits statement handy, take note of you who speak to, escalate to a supervisor or case manager if necessary and if all else fails you can make a complaint to NJDOBI or your local state board.
There is a script for calling your insurance carrier on page 8 of the Toolkit New Benefits for Breastfeeding Moms: Facts and Tools for Understanding Your Coverage under the Health Care Law