Frequently Asked Questions - April Rosenblum, IBCLC
Do you take my insurance?
I accept most Aetna plans and many Blue Cross plans. If you have a Blue Cross plan like Personal Choice, Keystone Health Plan East, Keystone POS, AmeriHealth PPO and AmeriHealth HMO, I should be able to bill your insurance directly for the visit, and you probably will not need to pay any copay.
However, *some Blue Cross plans* will tell you over the phone that I am 100% covered, and then will not pay the bill. Plans such as Anthem, Federal Employees, Horizon BCBS, for example, can be tricky this way. If you are wondering where your plan fits in, see the list of member ID prefixes in the next question.
If your insurance does not cover our visit, you will pay me out of pocket at the visit, and I will give you a receipt and instructions about how to file with your insurance company for reimbursement. I can't guarantee you will be reimbursed, but many people do get some money back.
What if I have Blue Cross, but not one of the plans listed above?
Look at your member ID on your insurance card. If the first 3 letters of your ID are on this list, I should be able to bill your insurance. If not, check with me before scheduling.
ADQ, AEK, AGE, APQ, ARR, ASE, AUA, AUK, BAL, BPB, BRD, BWW, BYN, CBE, CDJ, CDQ, CDZ, CHC, CNS, COS, CQA, CQX, CUI, CZN, CZS, DAZ, DBO, DFB, DGR, DKV, DPO, DQU, DVK, DVU, DWU, EEN, EGD, EIZ, EQJ, FFI, FJM, FQU, FSC, FYP, GCY, GEA, GEU, GJF, GJJ, GKV, GSN, HAJ, HKZ, HXT, ICC, IKE, IKF, IKM, INW, IUR, IXP, IXU, IYC, KPY, KXH, LFS, LLH, LMS, LRC, LUF, LYW, MFL, MGA, MGG, MGL, MNF, NPP, NZK, OBW, OCQ, OCR, OCZ, OMJ, OPY, PAH, PBT, PBX, PDA, PRP, PSM, PTA, PUI, PUQ, PXF, QCG, QCH, QCI, QCJ, QCK, QCL, RAE, RID, RJG, RLA, ROO, ROQ, SDA, SEZ, SFU, SHQ, SKH, SNC, SQT, SZA, TFE, TMB, TMW, TQJ, TRX, TWS, UBF, UBL, UDS, UFN, UFP, UFT, UHF, UJX, ULB, UPB, UTR, WHV, WIQ, WIV, WQB, WUF, YXF, YFK, YFO, YFP, YFQ, YXR, YFU, YXA, YXB, YXL, YXT, YXW, YXZ
Again, if your insurance does not cover our visit, you'll pay me out of
pocket at the visit, and I'll give you a receipt and instructions
about how to file with your insurance company to try to get some reimbursement.
Can you come to my home?
- I can usually do home visits within 15-20 minutes of 19143; every now and then my schedule allows me to travel a little farther. If you don't live in West Philly, the visit may need to occur in a specific time slot to accommodate travel, so there may be a longer wait for a home visit then for an office visit. If I'm not seeing you within a day or so, I'll want to talk to you by phone to help you figure out a plan to get you through until we meet.
- Some insurance companies will not cover a home visit unless it is medically necessary (for instance, if you are on bed-rest). To be safe, ask your insurance company about this before our visit (see above). Your doctor, midwife or pediatrician may be able to give you a note documenting that you require a home visit, or you can switch to an office visit if needed.
- Because insurance companies limit the length of your visit to as little as 60 minutes, when I do an office visit, I normally try to give families some extra time. Travel time for home visits makes this less feasible, so for families who prefer to have a slightly longer visit, coming to my office is better.
Do you take Medicaid?
Medicaid plans, such as Aetna Better Health and Keystone First, typically say that they do not cover IBCLC visits. It may be possible to get covered to see an IBCLC who has a separate specialty, such as Rachelle Lessen, a wonderful IBCLC and dietitian at CHOP.
What does a visit cost if I have to pay out of pocket?
The cost of your first visit depends on your financial situation, but ranges from $150-$250. Since this is not an easy expense for many people, I welcome clients to pay in smaller installments, a little bit at a time. Follow-up visits cost less - usually around $75. Because it is not easy for everyone to afford a follow-up visit after paying out of pocket for your first visit, I give out-of-pocket clients a longer first visit, plus up to 90 minutes of free follow-up care by phone, text or email after our visit.
What's the difference between an office visit and a home visit?
Home visits are not quite as long as office visits and sometimes require a longer wait, but they can be very helpful if you are not yet physically well enough after birth to travel or climb stairs, or if you need your baby to learn certain breastfeeding skills in the environment where you will most often be feeding. For clients who use a wheelchair, I always make a home visit available.
Where is your office?
West Philly Lactation is based in a home office 10 minutes west of the University of Pennsylvania, near 52nd & Spruce, in the 19143 zip code. (You'll receive details about how to get here when you reserve a visit.) Clients without cars travel here on SEPTA's 52 bus or 34 trolley.
Do I need to arrive early, for an office visit?
No - in fact, I ask that you don't come early. :) There's no waiting room here, and I use all of the time I have between clients to prep. Thanks!
If I can't get a visit with you, who is another IBCLC I can see?
In the Philadelphia region, we are lucky to have lots of good IBCLCs! One person I recommend is Linda Derbyshire, IBCLC. For her contact information, or for a longer list of local IBCLCs and which insurance each one takes, see www.pro-lc.org.
What does a visit include?
- IBCLC guidance with a full feeding, and if necessary with pumping or supplementing
- Pre- & post-feed weight of baby on a lactation scale to determine total milk transferred at breast
- Post-visit communication with your pediatrician and/or your doctor
- For clients without direct insurance coverage of their visit: Up to 90 minutes of phone, email or text support after your visit
- Post-visit research of any special issues raised
- Weight checks in our office at any age
- Spot for two in WPL's prenatal breastfeeding class if you become pregnant again, to prevent difficulties next time
Do I need to clean my house, for a home visit?
No. No matter how messy your house is, I promise you that I have seen worse, it won't faze me, and I don't judge. Seriously. Put down that vacuum cleaner and go take a nap. Or at least go scarf down a meal while you pump. ;)
Questions to ask
your insurance company:
- How many lactation visits am I allowed?
- Do I have to use these visits up by a certain time? (6 weeks, 1 year, etc?)
- Are lactation visits covered 100%, with no copay?
- Is April Rosenblum, IBCLC a covered provider?
- (If you would like a home visit:) Are home visits covered for everyone, or only in cases of medical necessity?
Did You Know?
Under Obamacare, all insurance companies are obligated to cover lactation 100%, but only Blue Cross and Aetna follow their obligation in this region, and their Medicaid members don't get to take advantage of this benefit.
All of these benefits are at risk if Congress repeals Obamacare.
You can do something to make it better!
Tell your representatives:
- You want coverage for lactation expanded, not cut.
- Medicaid patients should have the same access to quality care that all other families do.
- For Medicaid and other patients to get better coverage, Pennsylvania needs to grant licensure to IBCLCs.