“Will my insurance cover my visit? Are you in network with my insurance?” are understandably among the first questions many patients ask me.
It is very difficult for IBCLCs to become in network with most insurances, for a number of reasons I won’t go into here! The Affordable Care Act (Obamacare) mandates lactation coverage be offered to patients at no out-of-pocket cost; how well your insurance company complies with that can really vary.
For clients with coverage outside of The Lactation Network I ask for payment at the time of service – fees are listed in the scheduler below. I submit a claim to your insurance provider for your reimbursement following your appointment, no extra steps needed on your part. From there your insurance company should communicate directly with you, including sending any reimbursement check directly to you.
Unfortunately, Fidelis/Medicaid will not reimburse for lactation care provided outside of a medical office or hospital. Cayuga Medical Center offers outpatient lactation visits on a limited basis and tries to prioritize patients with Medicaid plans; contact the Birthplace at CMC for more information.
Requesting a gap authorization from your insurance
Some patients ask whether they should request a “gap authorization” or pre-approval from their insurance to pay for out of network lactation care, given that their insurance company has no local IBCLCs in network. You are welcome to do this, but note that it may take up multiple days for the authorization to process, and the authorization may not cover the full cost of care. Discuss with your insurance company what their reimbursement rate for out of network care will be, and what the length of the approval process will be, to decide whether you would like to go through this process. Below is some information they may request from me in order for you to apply for the exception:
In the Flow Lactation NPI: 1164936175
Diagnosis code: Z39.1 (care and exam of a lactating mother/person)
Procedure codes: 99404, 99403, and S9443
Please ask if you have further questions. I continue to seek ways to make lactation care more accessible and affordable for all.
When you’re ready to schedule, you can do so below. Please reach out to me directly if you have an urgent need for an appointment and/or do not see any times that work: