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.

For insurance eligibility verification, please submit your information here.

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 for insurance verification using the link above.

Anthem PPO, Blue Cross/Blue Shield PPO, and ANY insurance card with a Multiplan or PNOA logo.

I accept these plans by partnering with The Lactation Network (typically covering at least 6 lactation related visits at no cost to you) for out of network billing. Please submit your information for insurance verification using the link above and I will forward it to TLN for verification.

Cigna

I am able to accept Cigna (at no additional cost for Cigna members) by partnering with Wildflower Health. Please submit your information here for eligibility confirmation.

United Healthcare

I am in network with many UHC plans. Please submit your information for insurance verification using the link above.

Tricare:

I am a Tricare non-network provider for beneficiaries enrolled in the West region.

Tricare Select

No authorization/referral needed, you can schedule directly with me (either in person or telehealth) and you will be covered for up to 6 visits.

Tricare Prime

Please have your OB, midwife, or other health provider put in a referral. Instructions are below (and will depend on how they typically input referrals). The following information will be helpful to send them in order to makes sure your referral gets sent to me.

Instructions for referrals input using CareAffiliate (*REQUIRES Login)

https://www.tricare-west.com/CareAffiliate/ 

1.     Fill in patient and referring provider information (do NOT choose “Use for all requested services” as this makes the requesting provider also the servicing provider)

2.     Request type: P159 Breastfeeding Counseling

3.     Event Classification: Choose urgent (care within 3 business days) or emergent (care within 24 hour), if applicable, as lactation support is often needed in a timely manner. Clinical justification is required and may be input under the notes or assessment section: something like “infant not feeding effectively at breast” or “low milk supply impacting infant feeding”. For referrals requested during pregnancy, choose routine.

4.     Diagnosis code: z39.1

5.     Click on Service 1: click to fill out Servicing Provider info: Ariana Lapierre (Specialty listed under Birthing). May also backdate service date in this section, if needed.

6.     Click the box next to prepopulated CPT codes before submitting

Note: authorizations are valid for 365 days, so may be requested in advance/during pregnancy 

Instructions for referrals input using WARF (Web authorization/Referral Form) (*DOESN’T REQUIRE LOGIN)

https://www.tricare-west.com/content/hnfs/home/tw/prov/auth/symbolic_links/warf.html 

1.     Fill in patient and referring provider information

2.     Event Classification: Choose urgent (care needed within 3 business days) or emergent (care needed within 24 hours), if applicable, as lactation support is often needed in a timely manner. Clinical justification is required: something like “infant not feeding effectively at breast” or “low milk supply impacting infant feeding”. For referrals requested during pregnancy, choose routine.

3.     Diagnosis code: z39.1

4.     Request type: Outpatient Authorizations; P159 Breastfeeding Counseling

5.     Servicing Provider: use NPI to lookup: 1306324058 (Ariana Lapierre)

Note: authorizations are valid for 365 days, so may be requested in advance/during pregnancy

Other Insurance Plans/HMOs/No Insurance:

Depending on your insurance, you may try to get pre-authorization for our visit. 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” or “gap exception” which will allow a visit with me to be covered by insurance. Companies can still be difficult about paying, so I do require payment at time of service and will either submit a claim to your insurance company directly or will provide you with a superbill so that you can seek reimbursement (this will depend on whether a prior authorization number was obtained or not).

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

Contact me regarding discounted rates for those insured solely by Medi Cal.

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.