Insurance and Billing

New patients should call their insurers before the appointment to make sure Dr. O’Hara is in network for outpatient services.

Because you and baby are a team, we evaluate both the lactating parent AND baby (even if there are not perceived lactation issues). You will need to verify for insurance each of you.

• Dr. O'Hara is in network with most major insurance companies, but individual plans may vary.

• Due to contracting issues, the practice is only able to see United Healthcare patients if they pay out-of-pocket and do not submit for reimbursement from United Healthcare.

See below for questions to ask your insurance company.

Insurance Benefits Questions

Information you’ll want when you call:

Your insurance card and/or: Patient name(s), birthdate(s), Insurance Company Name and phone number, ID or policy number, and plan name (ex: Kaiser Core or Access PPO, Premera Heritage or Heritage +1, etc.)

What to ask:

• Are both myself and my child covered under this policy?

  • If child is a newborn, is there anything needed to add them to the plan that hasn’t been received?

• Is the provider MaryAnn O’Hara MD covered under this network/plan?

  • Tax ID (TIN): 523178638

  • NPI: 1528158466

• If she isn’t in network with this plan, are there out of network benefits available?

• Is a referral from my Primary Care Physician needed for this provider?

• Are the following CPT and Diagnosis codes covered for me and my child?

  * Please note that the following are the most commonly used codes, others may be used based on patient needs; additionally, make sure that they are checking under medical coverage (NOT dental coverage)

  • Office visit CPT codes (both mom and child): 99202-99205 range

  • Frenotomy CPT codes (child): 41010, 40806

  • Lactation issue Diagnosis code (mom): O92.79

  • Oral tie Diagnosis codes (child): Q38.0, Q38.1

• If this is baby’s 2nd frenotomy, will it still be covered?