Insurance

Please direct any questions and concerns regarding insurance to our billing department at 301-801-9070 or billing@metropolitanbreastfeeding.com  Thank you.

Insurance Information

Metropolitan Breastfeeding is committed to helping you understand and fulfill your insurance requirements so that you can get the medical attention you need. With all of the changes in insurance plans and high deductibles, we encourage you to check your specific insurance plan’s coverage, copay, and deductibles to avoid unexpected costs. Specific to newborns, please double check that your newborn baby is covered under your insurance plan before your visit. Our staff is available to assist you with any necessary pre-certifications.

We participate as an In-Network provider for the following insurance plans. Please note that there are sub-plans and products within each insurance company, and you should check your company’s website or call them to make sure we participate with your specific plan.

  • Aetna
  • Cigna
  • Carefirst
  • Blue Cross/Blue Shield
  • United Health Care

If you do not have health insurance, have insufficient coverage, or have a plan we do not accept, and you still want to be seen, our staff will notify you of our fee schedule.  Please contact billing@metropolitanbreastfeeding.com or call 301-801-9070 for more information.

Standard Billing Procedures

We utilize the services of a professional medical billing company that specializes in processing your insurance claims effectively and accurately. These are our standard billing procedures:

  1. Always bring your current insurance card with you to your appointment.
  2. The co-payment amount (there may be more than one due), required by your insurance company, is due at the time of your appointment.
  3. Our billing office will then file a claim with your insurance company.
  4. After we have received a response from your insurance company, you will receive a statement/invoice from us if any additional balance is due from you. These are usually due to deductibles, co-insurances, co-pays, or items not covered by your carrier.  For amounts less than $30 per patient, you will be automatically charged and sent a receipt, per our consent form procedures.  For amounts greater than $30, we will notify you by email before collecting payment within 7 days.  At that time you can change your payment details.
  5. We are required by law to collect these funds that are deemed the patient’s responsibility by your insurance company.

We accept the following forms of payment:

  • Cash
  • Personal checks
  • Visa, MasterCard, Discover, American Express
  • FSA cards

Insurance FAQs

Q. How do I fill out the CMS-1500?
Q: Do you accept insurance?

A: If you seeing us without using insurance benefits, we will provide you with a universally-recognized medical form that you can submit to your insurance company for reimbursement depending on your plan benefits. If you have questions about this process, please click here. We will happily make special accommodations depending on your situation.

Q. Does your company accept HSA/FSA accounts?

A: Yes, we do accept any HSA/FSA account with a valid Visa or MasterCard logo.

Q: What if my insurance company denies my claim?

A: Many times, insurance companies will reject a claim if certain unique criteria are not met.  These issues are often simple to resolve, and we would be happy to assist you in obtaining a resolution.  Additionally, please be advised that it is very important to check with your insurance company prior to receiving our services if you are unsure that your insurance company will reimburse you.  We do offer other options if your insurance company will not cover a visit with us, or if they will only cover a visit under certain circumstances.  Please send any communications regarding insurance claims to:

Metropolitan Breastfeeding
Billing Department
4927 Auburn Avenue, Suite 100
Bethesda, MD 20814
billing@metropolitanbreastfeeding.com
301-801-9070

Q: I am unable to submit this paperwork to my insurance company. Do I have other options?

A: We would be happy to submit your medical forms to your insurance company on your behalf.  For a $15 fee*, we will obtain your insurance information, properly complete your medical form, submit the form to your insurance company, send you copies of all documents which have been submitted, and provide limited follow-up with your insurance company.

*We will charge your credit card on file $15 for each medical form we submit to your insurance company.

Q: Can I purchase a breastpump from Metropolitan Breastfeeding using my insurance benefits?

A: Insurance companies are now offering their members free breastpumps available through DME (durable medical equipment) suppliers who are set up to bill insurance companies directly. The breastpumps offered by these suppliers are generally not sufficient for the duration many mothers intend to breastfeed. For this reason, we discourage mothers from using these “personal-use pumps,” and instead consider renting a hospital-grade pump. However, if you would still like to purchase your breastpump from Metropolitan Breastfeeding and attempt reimbursement from your insurance company, please consider that once a personal-use pump has been opened, it cannot be returned if your insurance company has failed to reimburse you for it.

The models available for purchase are the Medela Freestyle and the Medela Pump in Style. The pricing for these breastpumps is available upon request.  We can also order (for purchase) the Medela Symphony, which is a hospital-grade breastpump and is significantly more expensive than either the Freestyle or the Pump in Style.

Please click here for a complete listing of our breastpump purchase return policies.

Q: What information do I need to have before I place a call to my insurance company to verify possible benefits for your services at Metropolitan Breastfeeding?

A: Depending on what services you are interested in from Metropolitan Breastfeeding, it may be helpful to have the following information handy before placing your call:

  1. The name of the patient(s).  During a lactation visit, some insurance companies may consider the mother the patient, while others may consider the baby the patient.  Please be sure to ask this question, as it is helpful to know when completing your reimbursement form after you’ve received our services.
  2. The patient(s) date of birth.  If your baby is unborn, state whether you intend to have our services before or after delivery.  For your convenience, if you are picking up your breastpump prior to your baby’s birth, we would not start the billing cycle until the day your baby is born.
  3. The name of the insured.  This is the name that appears on the card for the plan you intend to use.
  4. The insured’s date of birth.
  5. Your Member ID Number.  This number will generally be assigned by your plan; however, there are insurance companies that use the member’s social security number for this purpose.  It is located on your insurance card.
  6. Your Group Number.  A vast majority of insurance companies utilize a group number.  It is located on your insurance card.
  7. Provider information.  Your insurance representative will ask if you have any information about the provider you wish to visit.  Please call 301-801-9070 or e-mail us at billing@metropolitanbreastfeeding.com to request this information.
  8. Services requested.  All healthcare procedures have codes assigned to them so insurance companies can quickly process claims without the need to decipher the exact service performed.  The following codes are for our primary services:

Service

HCPCS Code & Modifier

Lactation consultation

S9443-SC

Hospital-grade breastpump rental

E0604-RR

Breastpump purchase (personal-use pump)

E0603-SC

9. After providing your basic information, you may want to consider asking these questions to be as knowledgeable about your benefits as possible:

  • Do I have out-of-network benefits?
  • Do I have an out-of-network deductible that needs to be satisfied before I will receive benefits?  If so, how much of my out-of-network deductible has already been satisfied for this year?
  • If I have out-of-network benefits, what is the rate at which I will be reimbursed based on the procedure codes I have provided to you?
  • Do I need to obtain prior authorization for these services?
  • Do I need to obtain a prescription from my doctor if I do not receive a consultation from Metropolitan Breastfeeding but I do intend to rent a hospital-grade breastpump?  (For a downloadable prescription you can take to your doctor, please click here.)
  • Do I need to obtain a referral from my doctor if I intend to receive a consultation from Bethesda Breastfeeding?
  • Is it permissible to have these services performed prior to the birth of my child?
  • Are there any special requirements I need to keep in mind when I am ready to have these services performed?  (Insurance companies sometimes have requirements about where visits can take place and what type of provider can perform the services.)
Q: I'm having issues with my insurance company providing the coverage I expected. Do you have any tools for this?

A: Yes! The National Women’s Law Center has put together some very helpful forms for you to use.

Sample letter (Coverage Policy for Breast Pump)

Sample letter (Coverage for Lactation Consultant)

For an excellent resource in understanding your coverage under the new Health Care Law, click here. (Provided by the National Women’s Law Center).