Essential Lactation

Insurance for Aetna clients: Essential Lactation is in-network with Aetna. I am able to submit your fees for Aetna’s consideration. Aetna’s usual and customary allotment for each procedure will satisfy your account; ultimately, each client remains responsible for full payment for services. You are responsible for providing me with accurate insurance information and informing me of any changes in your insurance status; if you do not have coverage at the time of service, you will be responsible to pay me at my self-pay rate.

Insurance for Tricare clients: Essential Lactation is in-network with Tricare. I am able to submit your fees for Tricare’s consideration. Tricare currently allows 1 hour per lactation visit with a total of 6 visits allowed per birth or adoption. Prenatal visits can occur after 27 weeks gestation. You don’t need a referral for lactation care whether you have Prime or Select. If Tricare is your secondary insurance, you will need to request a letter from your primary insurance stating they don’t cover lactation visits. You are responsible for providing me with accurate insurance information and informing me of any changes in your insurance status; if you do not have coverage at the time of service, you will be responsible to pay me at my self-pay rate.

Insurance partnered with The Lactation Network (TLN) which includes BCBS PPO (and subsidiaries like Regence, Premera, Anthem), Multiplan, and now United Healthcare: These need prior approval. This organization helps parents and parents-to-be get the breastfeeding support they deserve, covered by their insurance. Once approved, TLN guarantees full coverage with these insurances for in-home lactation consultations with a registered IBCLC, like me, at no out of pocket cost. They handle the paperwork and bill your insurance directly while I am contracted to provide the services. To learn more and schedule a consultation with me, visit Lactation Network to see if you qualify!

Cash-pay clients: Including all self-pay, Out-of-Network insurances, or insurances not partnered with TLN. Examples are Molina, CHPW, Kaiser, and some others. I will provide you with a superbill suitable for you to submit to your insurance. The superbill (which will also serve as a payment receipt) will be coded appropriately to the level of service provided during the visit. You agree to pay me at the time of the visit (cash, check, credit card, or HSA). Prices vary by appointment type and are listed in the online scheduling system.

Payments: A credit card will be required for booking online, but won’t be charged until after the consultation and insurance has been verified. For self pay clients, payment is due on the date of service. Payment may be made electronically using a credit card or fund transfer. I use SquareUp to process payments. SquareUp meets the high standards of HIPAA and the banking industry for security and privacy with regard to financial transactions. Cash and check are also accepted.

If payment is a hardship: Please reach out to me directly by email or text and let’s chat. You deserve access to care regardless of insurance status or income.

Travel fee: Beginning September 1st 2024, all home visits will incur a $25 travel fee. This will not be reimbursable through insurance. You can use HSA or FSA funds for this fee. This was a very difficult decision as I believe home visits are incredibly important. However, in order to continue to offer this service and balance the cost of gas, maintaining a vehicle, and the time between visits this is the best option available. There will be office hours on Tuesdays as an alternative option for families. Thank you so much for understanding!

A Special Note about Sleep Coaching visits: Payment options for sleep coaching visits include: cash (office only), check (office only), HSA, or credit card which is processed through Square’s secure processing server.

Insurance companies do not allow for a sleep coach to bill for services directly. However, you may be able to use your FSA/HSA funds to cover our visits together. To ensure coverage with your FSA program, reach out to your plan administrator to find out the requirements for “sleep consulting services” and then you will want to get a “letter of medical necessity” from your child’s primary provider.

You can in most cases use your HSA card to pay for services, just keep your receipt in case they request proof of services rendered. For FSA, you will pay by cash, check, or card and submit your receipt to your plan for reimbursement.

Affordable Care Act: Under the Affordable Care Act most insurances are required to cover lactation services, but you will want to check with your plan to determine your benefits. For more information about getting reimbursed please visit the National Women’s Law Center Tool Kit.

Cancellation Policy: If you cancel greater than 24 hrs ahead of your appointment, no fees will be incurred. If you cancel 24 hrs or less, then you will be charged a $50 cancellation fee.