NYSHIP - New York State Health Insurance Plan

Does my insurance plan cover lactation consultations?

Home and Office Lactation Services are fully covered with no copay by The New York State Health Insurance Plan: NYSHIP

This includes prenatal education, lactation consultations, newborn, infant and child breastfeeding guidance; infant bottle feeding and first foods education; breast pump selection and education, flange fitting and breast pumping coaching appointments.

Preventative care provides education and lactation care. There is no cap on services provided as long as your plan is active and there is documented need for lactation consulting and education.

The easiest way to obtain fully covered lactation appointments is to Request an Appointment here.

The Lactation Network handles our billing for NYSHIP. We help you set up your account and give you a fully covered lactation appointment within 2-3 days.

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About The Lactation Network:

The Lactation Network (TLN) submits claims to NYSHIP on your behalf, and pays New Baby New Paltz/Donna Bruschi, IBCLC to provide your lactation education and consultation.

If you previously registered with TLN, you do not need to register again. You can see more than one Lactation Consultant if you choose. Email care@TLN.com to have New Baby New Paltz/Donna Bruschi, IBCLC added as a provider.

Lactation consultations are considered preventative care and a minimum of 6 visits per pregnancy/baby are encouraged. This includes prenatal and postpartum visits. The mother/lactating parent is covered 100% with never a copay or a deductible. Any other lactation consultations or classes that a mother may have received from other providers will not count as one of these 6 visits.

If a patient requires more visits due to medical need, they may be available when there is documented need. There is a visit counter in your patient profile screen.

Travel Fees may apply for a home visit more than 20 minutes from Highland, NY (ref: Google Maps)

Home visit travel fee:

I specialize in home lactation consultations and I travel up to 90 minutes.

+$0 - up to 20 minutes from Highland, NY.
+$30 - 21 to 30 minutes from Highland, NY.
+$60 - 31 to 45 minutes from Highland, NY.
+$90 - 46 to 60 minutes from Highland, NY.
+$120 - 61 to 90 minutes from Highland, NY.

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Request an Appointment here.

We check your insurance benefits and/or give you an appointment in the time frame you list as available. If you have a new baby or an urgent situation, your appointment will usually occur within a day or two.

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Self pay options:

Emergent Newborn Home appointment:

• Meet within 24 hours, 90 mins - $300. + Travel fee if needed.

Regular self pay options:

• 60 minute appointment - $175. + Travel fee if needed.
• 90 minute appointment - $250. + Travel fee if needed.
• 15 minute "Quick Question"; follow-up appointments; office or virtual only - $40.
  

I accept the following forms of payment:

Insurance pre-approval, approved TLN contract, cash, check, credit card, gift card, and Flex/HSA cards. Please let me know your preference on the intake form.

All clients must have a debit/credit/HSA card on file.

Your debit/credit/HSA card is used as backup payment source for a last-minute cancellations, co-pays, or if your insurance lapses. It can also be used to pay for lactation supplies, travel fees, and appointment fees as needed.

Cancellation fees

When you cancel more than 48 hours before the appointment, there is a no cancellation fee.

If you are sick, you must reschedule your appointment. An appointment can be rescheduled for illness ONE TIME at no charge. If you cancel your rescheduled appointment, there is a 100% appointment cancellation fee.

When you cancel your appointment with less than 48 hours advance notice, there is a $175 appointment cancellation fee charged immediately to your card on file.