Scheduling & Insurance
As breastfeeding involves both the mother and infant, our visits involve the evaluation and treatment of two patients.
Please call 216-291-9210 to schedule visits. The front desk at Senders Pediatrics will assist you. You can also leave a message at extension 123. When calling to schedule we will ask for insurance information as well the name of your primary provider for both you and your infant. This enables us to keep your providers informed after your visit.
We accept most major commercial insurances as well as straight Caresource (Medicaid) and Ohio Medicaid (ODJFS). Visits are covered by insurances as a physician office visit (99202-99215). At each visit, the infant and mother are assessed, evaluated and treated and a bill will be submitted to your insurance for each patient.
If required by your insurance company, a co-pay will be required for both patients and is due at the time of the visit. When contacting your insurance to check if services are covered (99202-99215) or a referral is needed, you are asking about a referral to a medical specialist in breastfeeding medicine (physician), not a lactation consultant. While we work with lactation consultants, a physician or nurse practitioner is part of every visit. If your insurance requires a co-pay for physician visits, and you want to inquire about these visits being a non-co-pay visit, you will need to contact your insurance company.
Increasingly there is interest in the Health Care Affordability Act’s coverage of lactation services. This is an evolving requirement for insurances and is being met with significant variability. Please note that if your insurance has lactation benefits these are covered under the mother’s benefit. Your baby’s evaluation and care which is part of the visit will not be covered under lactation coverage. Additionally, many insurances that offer lactation benefits cover general counseling but do not cover 100% visits for medical lactation difficulties such as plugged ducts, mastitis, infection, and evaluation of low milk supply. They will cover this as a medical visit and copay maybe required. It depends on the CPT codes that they include in their lactation benefits.
Questions you can ask your insurance company include:
1. Does my plan require a copay for non-preventive visits? If a copay is required, how much is it?
2. Does my plan include lactation benefits? If yes, how many visits are covered?
3. For those plans covering lactation: Do the visits have to be billed with a specific diagnosis code? or a specific visit procedure (CPT) code? If specific codes are needed, what are the codes?
4. For those plans not covering lactation services: Why don’t I have lactation coverage?
We ask for 24 hour notice if you need to cancel an appointment. This allows us to contact other patients who are waiting for appointments.
Please remember to add your newborn to your insurance plan
Most insurance gives you 30 days to add your newborn to the insurance plan. It is important to check as many insurances do not do automatically add your infant to the plan. If there is a lapse in coverage your insurance will make you responsible for the visit charges.
Do I need to be a patient at Senders Pediatrics to obtain services at Breastfeeding Medicine of Northeast Ohio?
No. While we are housed in the same building, Breastfeeding Medicine of Northeast Ohio is a separate entity. Patients and mothers, from practices all over the area, come for one-time or several consultations to receive breastfeeding support and guidance only. Patients at Senders Pediatrics simply gain from the convenience of our location just being down the hall from their primary providers.
- About Us
- Our Services
- Social Support