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Reimbursement for breastpumps and Lactation Consultant services

As a lactation professional or healthcare provider, you recognize the important role third-party reimbursement can play in fostering the rates of both initiation and duration of breastfeeding. Breastpumps – whether used for medical necessity of the mother or child, or by working mothers – play a vital role in increasing those rates. However, we also recognize that many obstacles currently stand in the way of a unified and successful breastpump reimbursement program across the country.

Recognizing these obstacles, Medela has enlisted the services of a highly-regarded healthcare consulting firm, The Lash Group. What has resulted is a complete set of reimbursement tools and documents that will assist lactation professionals and healthcare providers to help new parents gain reimbursement for the tools that will allow them to provide the best possible nutrition for their infants.

The complete set of reimbursement tools consists of a guide and materials that can be photocopied for non-commercial use, without further permission from Medela. All appropriate materials can be downloaded and used as handouts to expectant and new parents to assist them in submitting claims as well as appealing denied claims for breastpump/lactation services. There are additional letters that can be used by lactation consultants or healthcare providers to document medical necessity or to help appeal denied claims, a copy of a supply order form and a superbill, and a list of helpful hints in dealing with Medicaid claims.

Medela will continue to promote and support reimbursement for lactation equipment and services, recognizing that reimbursement is one of the most important factors in helping families initiate and extend the duration of breastfeeding. We are pleased to provide this information to you so you can assist even more breastfeeding families to achieve their objectives.

Related Files

• Healthcare Insurance Guide for Breastfeeding Families
• Superbill Step by Step Explanation
• Sample Superbill
• Sample Form - Prior Authorization Request Letter Template
• Sample Form - Letter of Medical Necessity Template
• Sample Form - Insurance Commission Letter Template
• Sample Form - Claim Denial Appeal Templates - Patient
• Sample Form - Claim Denial Appeal Templates - Physician
• Sample Paragraphs Illustrating Medical Necessity Templates - Physician
• Directory of State Insurance Commissions Addresses

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