(i.e., BCBS, CIGNA, United Healthcare, etc.)
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Unfortunately, many insurance carriers will not allow IBCLCs "In-Network" in our region. Therefore, I am considered "Out-of-Network" and payment for the consultation will be due out-of-pocket at the time of our visit (I will reply with fee information after you submit your request for an appointment). You will be provided with a Superbill after our visit that can be submitted by you to your insurance carrier in order to seek reimbursement from them for the fees you paid. However, I can not guarantee their reimbursement and I have no access to provide you with any benefit information.
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Per the Affordable Care Act of 2012 (ACA), Lactation Consultations are considered "Preventative Care" and therefore it is law that insurance carriers provide these consultations at no cost to the lactating parent (with the exception of certain "grandfathered-in" plans). Certain companies have a limit on the number of visits allowed for coverage. Please see NWLC BREASTFEEDING TOOLKIT for more information regarding this law and your rights to lactation care.
I recommend you call your insurance for information regarding your plan coverage for Lactation Consultations (consider the tips provided by the NWLC Toolkit for communication with insurance representatives). Record the name of the representative you speak to and a reference number for your files.
If you are uninsured or do not plan to submit a claim for reimbursement, I will provide you with a Good Faith Estimate for expected out-of-pocket costs in accordance with the "No Surprises Act"(see CMS.gov for information regarding this).
GAP EXCEPTION
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​​You can request a "gap exception" from your insurance provider when there are no IBCLC providers "In-Network" or none that are local to you.
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If approved, they should process the claim according to your "In-Network" benefits (with the Superbill I provide you after our visit).
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They may need the following information:
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Nancy Tsen, IBCLC
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Hackettstown, NJ 07840
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Phone: (973)349-5016
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Fax: (908)441-8775
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NPI#: 1992219869
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EIN#: 82-3520109
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Codes likely used:
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Diagnosis code: Z39.1
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Procedure codes: S9443, 99404, and 99344