Coverage, Fees & Service Areas

Smiling baby in yellow with a heart sticker on their cheek

Insurance

The following plans are likely covered with minimal or no cost sharing.
Check out FAQs below for more details.

AETNA: PPO, POS, OAP, EPO
BLUE CROSS BLUE SHIELD: PPO, EPO, Excellus, Anthem, Federal Employee
CIGNA: PPO, POS, OAP, EPO
UNITED HEALTH CARE & UMR

Check Your Insurance Coverage

 

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Insurance FAQs

Patient Relations
for Lactation Consultants of America
Phone: (323) 870-1150
Monday-Friday
10:30am-7pm EST
patient.relations@lcsofamerica.com

Most likely! I work through Lactation Consultants of America (LCA) to take lots of insurance plans, and they are constantly working hard to expand coverage. The ins-and-outs of insurance coverage frequently change, so I always run an insurance check through LCA’s patient relations team.

Being in network means the majority of your care should be covered, though it may not always be 100% coverage. 

You can do an insurance check through me by completing this form and sending me insurance information for you and your baby, or you can check directly with LCA’s patient relations team.

If you have questions related to feeding or lactation, all in-home, office, or telehealth appointments are covered. This includes appointments while you are pregnant, if you’re preparing to return to work, starting solids, or weaning. 

For some home visits outside my radius, I may require a small travel fee that is not covered by insurance. Scroll down for more details on travel fees. 

Most plans allow you to have as many visits as you need. A few plans, like Aetna and Tricare, have visit limits of 3-6 visits per baby. 

A check can take up to 48 business hours, but usually I receive a response much more quickly. 

This depends on your plan. If your plan considers lactation support to be preventative care, it should be 100% covered. If your plan does not, it may include cost sharing. Usually cost sharing bills are small (typically $0-$40). The best way to gather specifics is to check in with LCA’s Patient Relations team (contact info above) and also call your plan directly. Be aware that depending on the insurance plan representative you speak with, agents have been known to give incorrect or confused responses, in which case you can turn back to LCA’s patient relations for additional assistance.

To check with your plan: Call the number on the back of your insurance card and ask this question: “Do I have in-network coverage for lactation services under CPT code S9443 (lactation class) with diagnosis Z39.1, billed as professional services (not facility)?” Ask for a call reference number to help hold your plan accountable.

Postpartum lactation visits are considered care for both the parent and the baby, so each insurance plan is billed for half of the visit. I can accept two separate plans as long as both you and your baby are in-network.

It’s important that I check both plans ahead of time. If one person is not covered and this isn’t identified in advance, the uncovered portion is billed through Lactation Consultants of America at their standard self-pay rate of $175 per visit.

If I know ahead of time that only one plan is in-network, I can instead bill the uncovered portion directly through my private practice at a reduced rate of $80 per visit.

If this cost makes care hard to access, please reach out. Access to lactation care is a core value of my practice, and I’m always happy to talk through options or help connect you with support that fits your situation.

If you receive a bill from LCA that you weren’t expecting, or are having trouble covering a bill, I encourage you to contact patient relations (see above) and inquire about their financial assistance options.

You can check my self pay rates below. Private pay rates cover the cost of both parent and baby.

Please reach out without shame if care is inaccessible right now. I have been there and am always happy to explore how I can work with you or connect you to other resources in the area. All parents deserve lactation support and I am passionate about getting you the support you need!

If these FAQs didn’t answer your question, always feel welcome to reach out to Ellen at Nourishing Pathways.
Text/call: 315-217-1117
Email: ellen@nourishingpathwayslactation.com

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Smiling mother holding her baby close, facing the camera

Self Pay

If ineligible for insurance coverage, consultations may be paid out-of-pocket at the time of service. After each visit, I will provide you with a superbill that you can submit to your insurance company for potential reimbursement.

Pricing (Home Visit/Virtual):
Initial Postpartum Visit ($200/$125)
Initial Postpartum - Twins/Multiples ($250/$175)
Follow-up Visit ($175/$125)
Prenatal & Induced Lactation Planning ($150/$125)

*I DO accept HSA and FSA payments*

New York State WIC logo indicating that active WIC participants may qualify for discounted lactation consults

WIC Discount

If you are an active WIC participant, you may be eligible to receive a 40% discount on your consult. Please reach out to inquire.

Pricing at 40% Off (Home Visit/Virtual):
Initial Postpartum Visit ($120/$75)
Initial Postpartum - Multiples ($150/$105)
Follow Visit ($105/$75)
Prenatal Planning ($90/$75)

 

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Home visits in Ontario, Seneca, Yates and Wayne counties. 

Syracuse area consults available on a limited basis.

Telehealth anywhere in the world!

Book An Appointment
Places frequently served:
Geneva, Canandaigua, Newark, Phelps, Clifton Springs, Waterloo, Seneca Falls, Victor, Farmington, Bloomfield, Hopewell, Stanley, Shortsville, Gorham, Rushville, Liverpool, Baldwinsville, North Syracuse, City of Syracuse

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Travel Fees

Two adoring parents holding up their baby and smiling lovingly

I offer home visits within a 45 minute radius from Seneca Castle, NY (using Google Maps to calculate).

Visits are available on a limited basis in Syracuse, NY and nearby suburbs. (Please contact me directly to book for this region.)

Here is a breakdown of my travel fees:
*No fee up to 35 minutes from Seneca Castle
*$35 for 35-45 minutes away or Syracuse area visits

Travel fees are not reimbursable through insurance.

 

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