I accept many insurance plans, making lactation support often available with no out of pocket cost to you!

The ACA (Affordable Care Act) mandates that lactation support be covered as preventative care. Unfortunately, many insurance carriers make this benefit difficult to use by limiting IBCLC insurance participation. I have done my best to ensure my services are covered by a variety of insurance providers.

Aetna PPO:

I am in network with many Aetna PPO, EPO, OA, POS, and other plans (unfortunately not HMO). Aetna typically covers 6 lactation related visits with no cost sharing. For a full list of in-network plans, please click here. Please submit your information directly to me (via text or e-mail) for eligibility confirmation.

Cigna

I am able to accept Cigna by partnering with Wildflower Health. Please submit your information here to verify benefits.

United Healthcare

I am in network with many UHC plans (including some HMO, EPO, and POS plans).

Please submit your information directly to me (via text or e-mail) for eligibility confirmation.

Tricare:

I am in network for lactation. No referral necessary for those on Prime or Select!

Please submit your information directly to me (via text or e-mail) for eligibility confirmation.

Medi-Cal:

I am an approved Medi-Cal doula. I am waiting on contracts with Cal Optima and Kaiser. For those with Cal Optima or Blue Shield Promise (or another Medi-Cal plan), we can work on getting a single case letter of agreement (LOA) prior to meeting. This allows my services (as a non contracted provider) to be covered as if I were in-network.

Please reach out for any questions!

Other Insurance Plans/HMOs/No Insurance:

If you do not see your insurance plan listed, it is either because they do not contract with IBCLCs or I am waiting on a participation agreement.

For all other insurance plans, payment is due at time of service and I will provide a superbill that can be sent in for reimbursement.

For PPO plans, though not required, calling ahead of time and requesting an out of network exception will help ensure you are reimbursed. They may request provider information, this is provided below in the white box.

For HMO plans, you will likely need to get pre-authorization for our visit if you wish to be reimbursed. First, please reach out to your OB/GYN, midwife, or baby’s pediatrician to get a “referral” for lactation support. It will be helpful if it has my information (listed below in the white box). Call your insurance company, following the beginning of the “script” below. If they are able to provide you with a list of suitable in network lactation consultants, you may need to call and book with them. If, however, they are unable to provide you with this information, you can ask for an “in for out”, “gap” or “out of network” exception, which will allow a visit with me to be covered by insurance as if I were a network provider.

I do accept FSA/HSA cards and fee-for-service/self pay.

Contact me regarding discounted rates for those on WIC.

Please don’t hesitate to reach out with any questions you may have.

Health Insurance plans must cover women’s preventative services (including lactation support) at 100%!!

The law states that under the Affordable Care Act, insurers MUST cover, at no cost to the patient (no cost sharing/no deductible), “comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum period, and costs for renting breastfeeding equipment”. Click here for more information regarding this law and how you can ensure your insurance company complies.

Unfortunately, the language in this law is a bit vague, so insurance companies feel they have some ability to interpret exactly what “comprehensive lactation support” means, and who qualifies as a “trained provider”. This means that not all insurance companies are covering lactation services in exactly the same way. What does this mean for you and how do you know how your insurance company will handle this? Read on…

Private insurance: Most insurance plans are obligated to cover lactation services. The exception is older (“grandfathered”) insurance plans that existed prior to March 23, 2010, the date the ACA was signed in to law. Your insurance plan will prefer for you to see an “in-network” lactation consultant. However, most plans do not contract lactation consultants (Aetna is the exception). If your insurance company is unable to help you locate a network provider, they must allow you to see an “out of network” provider at no cost to you, typically through what is called a “gap exception” or out of network exception. Please call your insurance company to determine the status of your plan/ensure your lactation support will be 100% covered. It may be helpful to get a referral for lactation support from your baby’s pediatrician or your OB/midwife. If you have this, please mention it when calling your insurance company. See below for a sample script and information you will need to get an out of network exception, if needed.