What are your fees? Does my insurance plan cover lactation consultations?

I am an International Board Certified Lactation Consultant (IBCLC). Lactation services should be covered by your health insurance, in full, with no copay. That said, it's not always easy to figure out exactly what they cover.

The following plans usually cover my services with no (or low) out-of-pocket costs:

• Aetna
• Anthem/BCBS (Please allow up to 2 days for verification)
• Cigna
• The Lactation Network (Please allow up to 2 days for verification)
• United Healthcare
• VA/CNN
• Wildflower

Request an Appointment here

Home visit travel fee:

I specialize in home lactation consultations. There is no fee if you live within 20 minutes of Highland, NY. I will travel up to 90 minutes to Far, Far, Away Land.  (Use Google Maps to verify)

+$0 -   up to 20 minutes from Highland, NY.
+$30 - 21 to 30 minutes from Highland, NY.
+$75 -  31 to 45 minutes from Highland, NY.
+$100 - 46 to 60 minutes from Highland, NY.
+$150 - 61 to 90 minutes from Highland, NY.

Other plans:

CDPHP

CDPHP is good about reimbursing clients. You pay me out-of-pocket and then submit the paid invoice to CDPHP. 

Emblem

Some clients have "Requested An Exception" by calling the plan. The plan then calls me and we negotiate a payment. This can take up to two weeks.

MVP

MVP does not reimburse for lactation services. They offer their own virtual lactation consultant services. You pay me out-of-pocket.

Medicaid-Anthem/Fidelis/MVP etc.

I do not participate with any Medicaid plans. You pay me out-of-pocket and I offer a sliding scale for any household whose income is under $75,000. No documentation needed.

 

****************************************************

 

Request an Appointment here.

I will set up your insurance benefits and/or give you a cost estimate. If you have a new baby, or an urgent situation, your appointment will happen within a day or two. 

Securely upload your insurance information and cards here.

Check your insurance coverage only

I will check your insurance and give you the information and/or cost estimate 

Securely upload your insurance information and cards here.

 

If you call your insurance plan.

Ask them what you can reasonably expect. Write down the agent's name, what they said, and any reference numbers they give you. Sometimes, an insurance company agent will say your plan covers something, but then the claims department denies the claim. If this happens, I invoice you for the services you received, along with a Superbill/Receipt, and you can appeal. Persistence often results in the claim being paid.

I'm sorry. I am not a large company. I don't have a team of insurance billers. I spend my time helping mothers and babies, not chasing down itinerant insurance companies.

 

******************************************************

The Case for Paying Out-of-Pocket:

While insurance is nice, and necessary with birth and babies, sometimes it doesn't cover the lactation services you need.

Your baby and your boobs (or your wife's boobs) are depending on you to figure this out. 

My fee is similar to fee-for-service mental health therapists, physical therapists and massage therapists. Those people rarely make home visits, but I do, even on weekends.

All families rely on home visits for quality of life: Appliance Repair Techs, Cable Guys, Electricians, Plumbers, and Lactation Consultants are just some of the people who make house calls.

When you have a home emergency, you do expect to pay hundreds of dollars, because it's IMPORTANT and VITAL to the smooth running of your family life.

When you have a breastfeeding problem, everybody is worried and nobody is getting any sleep. I listen to your problems, kindly help you sort out the issues, and quickly resolve them.

I help you make immediate and long-lasting improvement in your current situation. I'm experienced, careful, and considerate of aches, pains and roller-coastering emotions. 

Your whole family will feel better.

Lactation counseling is short term therapy (days, weeks or months, not years) that improves your, and your baby's whole life.

Self pay options:

• 60 minute appointment - $150.    + Travel fee if needed.
• 90 minute appointment - $200.   + Travel fee if needed.
• 15 minute "Quick Question"; follow-up appointments; office only - $40.
  

Sliding scale - if your household income is less than $75,000 

• 60 minute appointment - $60-$150    + Travel fee if needed.
• 90 minute Initial appointment - $90- $200     + Travel fee if needed.
• 15 minute "Quick Questions"; follow-up appointments; office only - $30

Request an Appointment here.

I accept the following forms of payment:

Insurance pre-approval, approved TLN or Wildflower 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 and prepaid appointments are fully refunded.

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 less than 48 hours advance notice is given to cancel your appointment, there is a 100% appointment cancellation fee charged immediately to your card on file.

Gift Cards

Lactation Consultation E-Gift Cards are available for those you love. Email delivery.