Insurance & Billing
How insurance and billing works with our services.
Metropolitan Breastfeeding encourages all new patients to call their insurance companies directly to verify what the coverage will be for lactation services or breast pump rentals. When calling your insurance company, please note the provider will always be Dr. Kathleen McCue DNP, FNP-BC, IBCLC-RLC.
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 sliding fee schedule. Military discounts will be offered. Please contact firstname.lastname@example.org or call 301-943-9293 for more information.
Metropolitan Breastfeeding is committed to helping you understand and fulfill your insurance requirements so that you can get the breastfeeding support 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 that you may need. HMO plans require a referral.
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. Insurance plans we participate with include:
Anthem - Blue Cross Blue Shield
Blue Cross Blue Shield
Blue Cross Blue Shield - Federal Employee Program
Tricare (East Region)
United Health Care
*** We do not participate with any medicaid plans at this time.
It is important to note that Parent and baby are both patients during the visit and both may incur a copay, coinsurance, or deductible depending on your insurance plan. A travel fee will apply to all home visits.
How to check if you are covered for lactation services
1. If your insurance carrier does not have any IBCLCs in network and they will only cover services with in-network providers, you have a right to ask for an out of network exemption (or gap exemption). Make sure to ask for an exemption for several visits since most cases require 2-4 visits and more complex cases can require 6 visits. Here is the information you need from Metropolitan Breastfeeding to get pre-approval:
Provider Name: Kathleen McCue
NPI # 1932197738
EIN # 272370551
Tricare Patients: Metropolitan Breastfeeding
NPI # 1740621754
EIN # 272370551
Write the reference number, date, time and NAME of the supervisor or agent who tells you that you are covered. Ask them to note your file and if possible, to send you confirmation of the conversation and the information they gave you regarding the coverage under your benefits.
2. It can be useful to get a referral from your pediatrician and or your OB for lactation support, though it is not legally required. If you get a referral, mention this when speaking with your insurance carrier.
Standard Billing Procedures
We utilize the services of a professional medical billing company that specializes in processing your insurance claims effectively and accurately. Remember, both mother and baby are considered patients and will be billed accordingly. 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 $100 per patient, you will be automatically charged and sent a receipt, per our consent form procedures. For amounts greater than $100, 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
Personal checks, Visa, MasterCard, Discover, American Express, FSA and HSA cards