Insurance

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:

• 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.
• Adds copays, coinsurance, or deductibles to the baby’s claim.

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.

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.

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.

For most PPO and EPO plans, there is no need for a referral. If your plan is an HMO and pre-certification or physician referral is required, we are happy to obtain those for you.

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.

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.

We are unable to take Medicaid plans at this time. Payment plan options are available for self-pay clients.

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.