Insurance

 
 
 
 

In-network with CDPHP and UnitedHealthcare

 
 

CDPHP

Always best to call your insurance company to check for yourself, but our experience with CDPHP has been:

  • Fully covered (no copay, deductible, etc.)

  • Unlimited number of visits

  • Same coverage for all plans, including CDPHP Medicaid

  • We bill only for the parent and use code S9443 or S9445

 

United Healthcare

Always best to call your insurance company to check for yourself, but our experience with UnitedHealthcare has been:

  • Home visits and office visits are fully covered (no copay, deductible, etc.)

  • Unlimited number of home visits and office visits

  • Telehealth (virtual) visits are not covered

  • A few Oxford plans (Liberty Network, Metro Network, and possibly others) require prior authorization (We can do this for you after you’ve booked and provided your insurance information on your intake forms.)

  • We are out-of-network for some plans, including The Empire Plan (See Q&A below for more information about The Empire Plan) and UnitedHealthcare Community Plans (Medicaid)

  • We bill for both the parent and the baby, using code S9443

 

What is the process for using my insurance? If you provide us with your CDPHP or UnitedHealthcare insurance information for yourself and your baby, we will send claims to your insurance and your baby’s insurance. Your insurance company will send payment to us directly.

 

What if my baby is on a different insurance plan than me? When the lactating parent has coverage through UnitedHealthcare and the child is on a different insurance plan that is not UnitedHealthcare or CDPHP, you will pay a $125 fee for the child at the time of your visit. A superbill will be provided, which you can use to submit a claim for reimbursement to the child’s insurance company. There is not a fee when the lactating parent has CDPHP, regardless of the child’s insurance. The fee does not apply for Prenatal Consults.

 

What is the process if I have a different insurance company? For all other insurance companies, we do not bill insurance for you, but we will provide you with a superbill that you may use to file a claim with your insurance company. You will provide payment to us, and then you may seek reimbursement from your insurance.

If reimbursement is important to you, we strongly encourage you to check with your insurance company about your coverage prior to scheduling an appointment. You may want to ask things like:

  • Do they have any in-network lactation consultants who can come to your home or with an office near you?

  • If they don't have any in-network LCs, will they fully reimburse you for an out-of-network LC, at the full rate charged by the LC?

  • Do you need to obtain prior authorization?

  • What information do they need from you to obtain reimbursement? Is there a form?

If you plan to schedule a video consult, be sure to ask specifically about your coverage related to telehealth lactation support.

More information about legal requirements for insurance companies to cover breastfeeding support services can be found here.

 

I have The Empire Plan / NYSHIP and they’ve told me I can be reimbursed for seeing any lactation consultant. How does this work? Though we are out-of-network with The Empire Plan, it has been our experience that clients are reimbursed in full for an unlimited number of home visits. You will pay the standard fee at the time of your visit. Rather than providing you with a superbill for you to request reimbursement, we can submit the claim directly to The Empire Plan for you. Our clients have sometimes received a check from The Empire Plan reimbursing them in full in as little as 3 weeks after their visit, however we’ve seen an increasing number of claims processing errors from The Empire Plan lately, which can delay payment by a few months. Telehealth visits are only partially reimbursed.