LACTATION CONSULTATION COSTS AND INSURANCE
Dr. Garcia is in-network with most major insurers in the State of Michigan including Straight Medicaid.
As breastfeeding medicine consultations involves both the breastfeeding parent and infant(s), our visits involve the evaluation and treatment of multiple patients who will be billed independently.
If required by your insurance company, a co-pay will be required for both patients and is due at the time of the visit. It is also possible to file for out-of-network insurance reimbursement or pay for lactation services out of pocket.
If you do not have insurance, please let me know to determine sliding scale payment.
When contacting your insurance company to check if services are covered, or if a referral is needed, you are asking about a referral to a medical specialist in breastfeeding medicine (physician), not a lactation consultant. While we work closely with lactation consultants, Dr. Garcia is part of every visit.
Medicaid (Aetna, BCN, McLaren, Meridian, Molina and Priority Health)
Accepting Patients Right from the Start
Aetna, Blue Cross Blue Shield of Michigan, BCN, Cofinity, Coventry, Healthscopes, McLaren, Meridian, Priority Health, United Healthcare
Accepted Private Insurance Providers
Insurance Billing FAQs
For all insured patients, the Dr. Garcia will bill applicable third-party payors (based on information provided by or verified by the patient) in a timely manner.
If a claim is denied (or is not processed) by a payor due to an error by Dr. Garcia, Dr. Garcia will not bill the patient for any amount in excess of what the patient would have owed had the payor paid the claim.
If a claim is denied (or is not processed) by a payor due to factors outside of Dr. Garcia's control, Dr. Garcia will follow-up with the payor and the patient as appropriate to facilitate resolution of the claim. If resolution does not occur after prudent and timely follow-up efforts, then Dr. Garcia may bill the patient or take other actions consistent with current regulations and industry standards.
What if you are not in-network with my insurance?
You can still file for insurance reimbursement for breastfeeding medicine services. We will collect a fee at the time of service, then provide a Superbill you can file with your insurance.
How can I check my insurance benefits?
Contact your insurance company to learn the specifics for your plan.
Increasingly there is interest in the Health Care Affordability Act’s coverage of lactation services. This is an evolving requirement for insurances and is being met with significant variability. If your insurance has lactation benefits these are covered under the mother’s benefit. Your baby’s evaluation and care which is part of the visit will not be covered under lactation coverage. Additionally, many insurances that offer lactation benefits cover general counseling but do not cover 100% visits for medical lactation difficulties such as plugged ducts, mastitis, infection, and evaluation of low milk supply. They will cover this as a medical visit and copay maybe required. It depends on the CPT codes that they include in their lactation benefits.To better understand your costs, questions you can ask your insurance company include:
Does my plan require a copay for non-preventive visits? If a copay is required, how much is it?
Does my plan include lactation benefits? If yes, how many visits are covered?
For those plans covering lactation: Do the visits have to be billed with a specific diagnosis code? or a specific visit procedure (CPT) code? If specific codes are needed, what are the codes?
For those plans not covering lactation services: Why don’t I have lactation coverage?
We ask for 24 hour notice if you need to cancel an appointment. This allows us to contact other patients who are waiting for appointments.
Please remember to add your newborn to your insurance plan
Most insurance gives you 30 days to add your newborn to the insurance plan. It is important to check as many insurances do not do automatically add your infant to the plan. If there is a lapse in coverage your insurance will make you responsible for the visit charges.