Insurance
March 6, 2026 2026-03-09 20:19Insurance
Lactation Care & Insurance Coverage
At My Pure Delivery, we are committed to helping families use their lactation benefits while maintaining the highest standard of individualized care. We believe that cost should never be a barrier to getting the lactation care you need, and our in-house billing team will do everything possible to get your visit(s) covered. Most health insurance plans are required under the Affordable Care Act (ACA) to cover lactation support without cost-sharing when provided by an in-network provider. Coverage details vary by plan, deductible, and network participation. Please see the FAQ below for more information.
For in-network providers, we bill your insurance directly. We do not provide superbills for self submission. You are responsible for any applicable copay, coinsurance, or deductible required by your specific plan
**Special note for AETNA Policyholders**
Effective September 1, 2024: Aetna has changed their allowed billing codes for lactation services, which puts limits on the time we can spend in our consults and reduces the number of visits that will be fully covered. Please see our Acknowledgments for Aetna Clients document for details.
To verify that we are in network with your specific plan, please go to your insurance website and search for “lactation consultants” in the provider search or “find a doc” section of the website. If you and your baby are on different policies or have different carriers, you’ll need to check both (assuming we are seeing both you and your baby). You may need to call and speak to a representative about the specifics of your plan’s benefits.
Some plans are exempt from ACA compliance regarding lactation services, including plans that are grandfathered in before the ACA, or Restricted Access Plans.
If there is no lactation provider within a certain radius of your home, we may be able to get you an Out-of-Network Exception. This allows us to bill an out-of-network provider as though we are in-network.
Some plans are exempt from ACA compliance regarding lactation services, including plans that are grandfathered in before the ACA, or Restricted Access Plans.
Typically, there is no out of pocket cost for our services. However, there may be limits or exceptions with your specific plan, and you may have copay/ coinsurance/ deductible or ‘patient responsibility’ applied according to your plan limits and the carrier’s policy. In some cases, we will do a pre-verification of benefits to check for known exclusions that may result in denial of our claims, but ultimately, you are responsible for knowing and confirming your benefits. Any charges due will be assessed and charged to your card on file after claim settlement, which is usually 30-60 days after your appointment. We will not charge your card until the claim has come back and you have been notified.
You might be responsible for partial payment if your plan:
Adds copays, coinsurance, or deductibles to the baby’s claim.
Doesn’t cover lactation visits billed to the baby’s plan.
Puts a cap on the number of visits and you’ve used them all up for either the baby or the parent.
When both you and your baby are in our care, we will submit claims on behalf of both. If we can’t bill an insurer for either the lactating parent or baby, you will be responsible for half the self-pay rate for your consult. There may be an amount owed if your plan does not cover lactation visits billed to the baby, or if your plan has a cap on the number of visits and you’ve used them all up for either the baby or the parent.
For mom-only focused visits (for example, exclusive pumping or other issue that does not involve the baby directly), only the mother’s insurance will be billed.
Cedar Park area: In-home services are typically covered similarly to in-clinic services, however we do extend a self-pay convenience fee for in-home visits. This fee starts at $75 and is calculated based on round trip mileage to your location.
Plano area: We are not offering in-home services at this time. HIPAA compliant online video consults are available for those who cannot come to our office locations, and many plans include telehealth coverage for online lactation services.
If your plan is an HMO and pre-certification or physician referral is required, we are happy to obtain those for you. For most PPO and EPO plans, there is no need for a referral.
We ask that you authorize us to save the card on file and use it to process the following fees in accordance with our financial agreement:
- Late cancellation / rescheduling / no show fees
- Copay/ Coinsurance / Deductible
- Non covered / denied services
- Non covered patient fee for mom or baby who does not have billable insurance
Insurance policies vary and exclusions may apply. We will do everything possible to get your visit(s) covered, but please be aware that verification of benefits is not a guarantee of eligibility or payment. Final determination is made by the insurance provider upon claim submission and is based on the terms and conditions of each specific plan.
We will never charge your card on file without notice and a detailed explanation, and you can opt to change the payment method at any time.
Self-pay rates are time-based, and will depend on how much time is needed to address your individual needs. Costs range from $125-250 for most families with single babies. Please understand that rates are based on the time slot reserved. Due to the nature of our business and the extended time required to serve our clients, appointments run on time and we cannot go over the allocated time slot. If you are late for your appointment, your time will not be extended and no refund will be issued. Also, if the full time allocated is not used, no refund will be issued.
Payment is required at the time of booking. Payment plans are available. In the case you need to reschedule or cancel your appointment, you will be issued a full refund as long as a minimum of 24 hours notice is given. A $25 rescheduling fee or $50 cancellation fee will be deducted from your refund for appointment changes within 24 hours of the scheduled time. No call no show appointments will not be refunded.
Unsure if we take your insurance? Fill out our Lactation Consult Request form and we’ll take a look at your plan before booking your appointment. We will do everything we can to get your visit(s) covered. Our goal is to remove the cost barrier to you getting the help you need!
Insurance policies vary and exclusions may apply. Please be aware that verification of benefits is not a guarantee of eligibility or payment. Final determination is made by the insurance provider upon claim submission and is based on the terms and conditions of each specific plan. If you have questions, please contact your provider for plan details.
Lactation services are a covered preventative benefit per the Affordable Care Act and should not be subject to cost-sharing. However, each policy is different and coverages may vary, so please check with your provider for details.
For more information on what insurance should cover, how to go about getting coverage for lactation related products and services, and submitting appeals to your insurance company, click here to access the Insurance Tool Kit.
📹 Watch our video: How To Get Reimbursed For Your Lactation Services
