Hello!
I've been sitting on the sidelines reading the wonderful information,
comments, and shared knowledge.  I've been a LLL leader for almost 9 years,
IBCLC for 3, and recently started my private practice.  I thought I'd share
some of my experiences recently as I am learning the insurance ropes.  Some
of you may already be accepting insurance and I'd love to hear what is
working for you.  Unfortunately, I have spent way too much time setting
this up and can only hope that it will pay off in the long run.  I have
been modelling my practice after a friend's successful pediatric PT
practice as far as fees for service go and insurance submissions. My main
payers (insurance co) are BCBSAZ, Aetna, Cigna, United Healthcare, and
Golden Rule.

Figure out your fee structure and don't sell yourself short.  Physical
therapists charge between $150-300/hr and our services are equivalent in
evaluations, assessments, coordination of care, and counseling.

File for EIN from the IRS

Request NPI for myself and my practice

Keep a copy of your IBCLC certificate on hand for copies and your liability
insurance.

I use officeally ( http://www.officeally.com/) for maintaining client data
base and submitting electronic claims.  It is free for hcp to use and they
provide free tutorials on how to use their system and submit basic claims.
 I use the superbill feature all the time.   I used the ILCA website as a
tool for the cpt codes:
http://www.ilca.org/files/USLCA/Committees/Licensure%20and%20Reimbursement/Reimbursement%20FAQ%20Article%20for%20USLCA%206-2012%20v2.pdf
.
 It is HIPPA compliant

I had to register individually with each insurance company as an out of
network provider as I go through the in network provider steps.
- except Cigna- although Cigna is the absolutely least
helpful as they do not know what to do with IBCLCs and have given me the
runaround with incomplete solutions to problems for the past two weeks!  I
am beginning to suspect they may be avoiding (intentionally or
unintentionally) the requirements of the aca for lactation services by not
credentialing or contracting with IBCLCs and therefore can force mothers to
use out of network benefits for services or go through many hoops to
receive an in network provider exception waiver. If any of you have had
success with CIGNA, please share how you did it.

I spend a lot of time on hold as insurance companies figure out how to
classify IBCLCs, but most are helpful and friendly when I remind them of
the affordable care act.  http://www.hrsa.gov/womensguidelines/

Aetna has been the easiest to work with and the most helpful.

Once you file a claim and begin the registration process with a major
insurance co, you can request credentialing.  I received my CAQH # through
Aetna's credentialling process.  Once you receive a CAQH# you will have an
easier time with the other companies to become an in network provider ( I
use easier loosely, there is still a slew of paperwork).
http://www.caqh.org/

I have been working on this off and on for about 2 months.  I have received
a payment from Aetna for only $5 less than the amount.  The patient was
responsible for the remaining $5.  So not too bad as far as reimbursement
goes.  I have about 20 claims I am currently waiting on from other Payers
and will let you know what I learn as I go along.  I have to do a lot of
follow up calls
and clarify that I am not the obgyn and they do not usually provide the
same services as an IBCLC in my area.

Until you receive in network status, you can precert for moms for lc
services as an office visit.  While I have a physical "office"  I charge
the same for office and home visits and consider it a mobile "office"  when
I do a home office.  If you do not differentiate, the insurance won't
either.

I keep a file on my computer for insurance correspondence, since it is all
about the same and tweak it for the company, same with fax sheets.

I have warned moms that I will submit to insurance, but as the companies
and I learn the ropes, it will probably take 12-16 weeks for reimbursement.
 For now, I have moms pay a portion, that I will refund when I recieve the
check from insurance.  Once it is going more smoothly, I'll only charge the
copay the insurance sets forth.

Hope this helps some of you and if you have any questions, I'll answer them
the best I can.  Please share your experiences as well.

Warmly,
Desiree Allison, IBCLC, LLLL in Chandler, AZ

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