I am a participating provider with the Aetna network. If your health insurance is through Aetna, your visits will usually be covered in full, with no out of pocket costs. I can file the claim directly, and no payment is required on your part. Of course you should call Aetna to discuss the specifics of your plan and ensure that this is the case for your specific plan. Please note that a few Aetna plans require referral from a physician. It is your responsibility to obtain such a referral if needed for insurance purposes.
*BLUE CROSS / BLUE SHIELD PPO, ANTHEM BCBS PPO, CIGNA PPO, and some UNITED PPO Plans*
If you are a participant with one of these plans, you can find out quickly and easily if you can be preapproved for 6 visits covered in full via the Lactation Network (TLN). Pre-Approval MUST be requested and obtained through the Lactation Network in advance of our visit, fortunately this is very simple! Please go to Lactation Network, and fill in your contact and insurance information. You will receive an email letting you know if you are approved for full coverage, usually within a few hours. If you are approved, then your visits will be directly billed through the Lactation Network to your insurance provider, and you will not be responsible for any out of pocket costs, except for travel fees for home visits over 30 minutes away, if relevant. You may receive an Explanation of Benefits (EOB) from your insurance company, but this is NOT a bill, and you will not have any payment responsibility regardless of what appears on the EOB. I am a contracted provider for Lactation Network, and will receive my standard fee from TLN directly. If your coverage is not approved by the Lactation Network, see information below for other Private Insurance Coverage
CDPHP provides a simple form to allow their eligible members of employer sponsored plans to apply for reimbursement for Out of Network Lactation Care, which can be found here: CDPHP Lactation Support Reimbursement Form. You need to check that this applies for your particular plan. I am an Out of Network provider, so CDPHP members will still need to pay out of pocket before being reimbursed. I cannot guarantee that CDPHP will reimburse you, however I know that they have consistently done so in the past.
*NYSHIP / Empire Plan*
NYSHIP routinely reimburses members for Out of Network Lactation Care. You need to check with your insurance provider that this applies for your particular plan. I am an Out of Network provider, so NYSHIP / Empire members will still need to pay out of pocket before being reimbursed. I cannot guarantee that NYSHIP will reimburse you, however I know that they have consistently done so for lactation clients in the past.
*Other Private Insurers Not Listed Above*
Most private insurance companies are required by the Affordable Care Act to cover Out of Network lactation care without copay or deductible. However, the way this plays out in reality is complicated and depends a great deal on your individual policy, as well as how much time you put into talking with your insurance company.
I cannot guarantee that you will receive reimbursement and I cannot submit claims to insurance for you. You will need to do this yourself, after our visit(s). I will provide you with a Lactation Superbill with all the necessary codes that you can use to submit to your insurance company for reimbursement. You may also choose to use the Better app which makes it very easy to upload and submit your bill to your insurance company, and provides assistance in any appeals that may be necessary. They do take a small percentage of any reimbursement in payment for their service. See their website for details at https://getbetter.co/
If your time allows, I encourage you to call your insurance company before our visit, request pre-approval, and emphasize 1. that this is an urgent situation requiring an expedited decision (your baby needs to eat!), and 2. that there are no "In-Network" IBCLCs providing home visit lactation care in our area, so you will need to see an "Out-of-Network" provider, and would like preapproval for a "gap exception" allowing you to do this. This can ease the process.
Even if you are not able to call in advance of your visit, I encourage you to submit your Lactation Superbill to your insurance company after your visit, and should reimbursement be initially denied, or only partial reimbursement given (a favorite tactic of some insurance companies), I encourage you to appeal that decision. You are legally entitled to FULL reimbursement! Some insurance companies, unfortunately, seem to routinely deny the first request, or offer only a tiny reimbursement, betting that tired new parents will just get discouraged and let it drop, but they will often (though not always) reimburse fully if you are persistent.
The National Women's Law Center has some great information that you can refer to regarding your rights to insurance coverage for lactation care, and how to appeal any denials of claims: Toolkit Facts and Tools to Understand Your Coverage. You can also find helpful information, advice, and Sample Appeal Letters here, from an insurance savvy Lactation colleague in MA. And I am happy to provide a sample appeal letter that a local family used to successfully argue for reimbursement. No guarantees of course.
***WIC / Medicaid Participants and SNAP Participants may pay a reduced fee. See Financial Assistance page.***
Schedule a Visit
Text or Telephone (518) 672-1519,
email to Sarah@HeartsWorkBreastfeeding.com
Weekend appointments are often available if needed.
When making contact to schedule a visit, please indicate your:
Telehealth or a Home Visit Preference
Urgency for being seen
I make telehealth visits to anywhere with a good internet connection, and In Person visits within approximately 40 minutes drive of Chatham, NY, which includes all of Columbia County, and sections of Greene County, Renssalaer County, Albany County, and Dutchess County, NY, and Berkshire County, MA