Crash Course in Billing & Insurance for Lactation Private Practice
Everything you ever thought you would need to know about insurance billing and reimbursement for lactation services. Whether you are out-of-network or in-network, you’ll learn what you need to know to maximize what your clients get reimbursed and what you can get paid for lactation services.
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- Understanding Lactation Services and US Law
- Applying to be in-network
- Coding & Code Lists
- Sample Coding Scenarios
- Creating Your Fee Structure
- Getting Paid
- Contracting with Physicians and other Outpatient Providers (Incident-to billing)
- Aetna specific resources
- Tricare specific resources
- Tech handbook
- Words of wisdom from other lactation consultants
Many thanks and all the love to my family, who are so incredibly patient, loving, and supportive of this and all my other crazy ideas and endeavors. Special thanks to Joyce Pye Funston IBCLC for the Aetna coaching session that helped get my head on straight, and to Lea Rivera IBCLC and Sarah Eichler IBCLC for sharing their personal experiences with Aetna with me. Linda Strauss, Esquire, reviewed relevant portions of this book to keep it from getting legally out of line, and Michael Morgan, my indefatigable biller, who provided insight and guidance into the more technically tricky parts of this manual. Thank you to Rachel King IBCLC for being so helpful in reviewing the book and giving me helpful notes. Finally, to the members of my Facebook group, thank you for building such a great community where we can lift each other up as ethical and compassionate professionals.
Annie Frisbie MA, IBCLC is the author of IBCLC Private Practice: From Start to Strong and Paperless Private Practice for the IBCLC. In 2018 she received the USLCA President’s Award for her contributions to the lactation community. She is in-network with Aetna with a private practice in New York City.
I feel, at times, I am a voice for the baby. The first voice I heard was the hungry, demanding voice of my baby girl Cori. After struggling for days, my wonderful and supportive husband Paul chimed in and said we should go to see a Lactation Consultant. After sixty minutes of enlightening education and empowering support with her, I went on to successfully breastfeed two children - my daughter Cori and my son Kyle. I became a Nursing Mothers’ Counselor and then an IBCLC. I have too many to mention by name, but please know I am deeply grateful to ALL my family, ALL my friends and ALL my fabulous colleagues for your support and guidance in my life and in this project.
Donna Sinnott has been an IBCLC since 2001. In addition to her work as a lactation consultant, prenatal breastfeeding educator, and Pathway 3 mentor, she has spoken on the topics of billing, coding, and documentation for USLCA, ILCA, LCinPP, and other regional conferences.
Our customers say
Jayne Carpenter (she/her) CBS, LC, Peer Counselor
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