Reimbursement

Reimbursement

If your insurance is not pre-approved, fees are reimbursable by most plans, except Medicaid plans. I will give you a Superbill that you can submit for reimbursement.

You will be reimbursed in-full, or in-part, depending on your plan. To be sure what reimbursement coverage your plan offers, call the customer service number on the back of your insurance card and inquire about "Lactation Consultation benefits."
 
Often, your insurance company will tell you a lactation consultant must be "in-network" and you will find that their in-network consultants only work in hospitals, or there are none in the area. You can be reimbursed if you "request an exception" to see a lactation consultant "out-of-network" who will come to your home. This has been effective with Emblem and CDPHP.

 

Be Persistent

Expect to get conflicting information and answers from your insurance company. They prefer to not pay claims, because they are in business to make a profit for their shareholders. If they can delay you, they know you will give up, and their company's profit goes up.
 
Make notes and take names. Parents who are persistent with insurance companies are often reimbursed after a few calls, and/or escalating a complaint to a supervisor.

Aetna

I am in-network with Aetna. I will file a claim for each consult we have together and accept the negotiated amount as payment. You are responsible for any charges Aetna says are yours. I will give you a receipt and if you want reimbursement, you can dispute the charges with them.

 

Self pay options

• Home Lactation Consultation, 90 minutes -- $300 per session
• Office Lactation Consultation, 90 minutes  -- $200 per session
• Telehealth Lactation Consultation, 90 minutes -- $150 per session
• Short Session, phone, video or office -- $40 per 15 minutes. ‘Quick Questions’, Follow-up appointments, and small problems are scheduled using short sessions.

 Each time you make a payment, I will give you a receipt and a Superbill that you can send to your insurance company for reimbursement.

 

Sliding scale

If your household income is less than $75,000 I offer a sliding scale.

Each time you make a payment, I will give you a receipt and a Superbill that you can send to your insurance company for reimbursement. If you are on a Medicaid plan, you will not be reimbursed. 

 

Lactation Packages 

Each time you have a lactation consultation, I will give you a prorated Superbill that you can send in for reimbursement for that visit.

 

Travel fees for Far, Far, Away Land

Travel fees are not reimbursable.

 

Your credit card on file.

When your credit card is used as payment for an appointment or medical supplies (pumps pump parts, I will give you a receipt and a Superbill for reimbursement.

 

Gift Cards

Gift Cards can be used for any lactation services. Gift cards are a gift and not reimbursable.

 

Cancellation fees

Cancellation fees are not reimbursable.