Insurance and Payment Information
Insurance:
- AETNA: I am in-network with Aetna. Please complete my visit request form here or call/text 917-992-4623 to schedule your visit.
- CIGNA: I am in-network with Cigna through my partnership with Wildflower Health. Please verify your coverage here before requesting a visit.
- If you have any of the following insurance plans, your visit may be covered through my collaboration with The Lactation Network (TLN). You must verify your coverage with TLN here before requesting a visit.
- United Healthcare PPO & HMO
- Meritain Commercial Plans
- Any of the following logos on your insurance card:
- First Health
- First Choice Health
- PNOA
- Multiplan
- Imagine Health
- Sutter Health
Self-Pay Fee Schedule:
For self-pay and out of network visits, full payment is due at the time of booking (cash, check, Venmo, or Zelle). I will provide you with a superbill that you can submit to your insurance for potential reimbursement. The superbill will be coded appropriately to the level of service provided during the visit.
For self-pay and out of network visits, full payment is due at the time of booking (cash, check, Venmo, or Zelle). I will provide you with a superbill that you can submit to your insurance for potential reimbursement. The superbill will be coded appropriately to the level of service provided during the visit.
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Home Visits:
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Office Visits:
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Telehealth:
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Out of Network Reimbursement:
The Affordable Care Act (ACA) mandates that most health insurance plans cover breastfeeding support, counseling, and equipment (such as breast pumps) without cost-sharing. Following our visit I will provide you with a superbill coded appropriately to reflect the level of service rendered, which you can submit to your insurer for potential reimbursement.
To ensure a smooth reimbursement process, some insurance plans may require pre-authorization. I strongly recommend contacting your insurance provider prior to our appointment to understand their specific policies. The button below links to a toolkit which includes sample scripts to use when calling your insurance.
If your insurance plan has no in-network lactation consultants, you may request a network gap exception. If granted, the insurance company will pay for out-of-network services at the in-network rate to make up for their lack of in-network providers. This is sometimes referred to as in-for-out. Find out more here. This process typically requires documentation, including a Letter of Medical Necessity from your healthcare provider (pediatrician, midwife, or OB/GYN), and potentially a prescription or referral. I'm happy to provide any information on my end that will facilitate this process.
Please be aware that reimbursement is not guaranteed. You are responsible for the full cost of the visit and must pay in full before or at the time of service.
The National Women's Law Center has published a helpful toolkit that provides information on coverage for lactation services under the ACA, and tools for parents including sample scripts and instructions for calling insurance companies and sample letters and instructions for filing appeals.
The Affordable Care Act (ACA) mandates that most health insurance plans cover breastfeeding support, counseling, and equipment (such as breast pumps) without cost-sharing. Following our visit I will provide you with a superbill coded appropriately to reflect the level of service rendered, which you can submit to your insurer for potential reimbursement.
To ensure a smooth reimbursement process, some insurance plans may require pre-authorization. I strongly recommend contacting your insurance provider prior to our appointment to understand their specific policies. The button below links to a toolkit which includes sample scripts to use when calling your insurance.
If your insurance plan has no in-network lactation consultants, you may request a network gap exception. If granted, the insurance company will pay for out-of-network services at the in-network rate to make up for their lack of in-network providers. This is sometimes referred to as in-for-out. Find out more here. This process typically requires documentation, including a Letter of Medical Necessity from your healthcare provider (pediatrician, midwife, or OB/GYN), and potentially a prescription or referral. I'm happy to provide any information on my end that will facilitate this process.
Please be aware that reimbursement is not guaranteed. You are responsible for the full cost of the visit and must pay in full before or at the time of service.
The National Women's Law Center has published a helpful toolkit that provides information on coverage for lactation services under the ACA, and tools for parents including sample scripts and instructions for calling insurance companies and sample letters and instructions for filing appeals.
Payment Policies:
For self-pay (out-of-network) clients, full payment is due at the time of the visit. Payments may be made by cash, check, Venmo, or Zelle. Montclair Lactation will provide a superbill suitable to submit to insurance for potential reimbursement. The superbill (which will also serve as a payment receipt) will be coded appropriately to the level of service provided during the visit.
Montclair Lactation is providing care to me and to my baby or babies; together we are all the client of Montclair Lactation. My initial visit includes 1 week of follow-up support by secure messaging, email, text, or phone. Continued support is available for a weekly fee of $40. These fees are elective and not eligible for insurance reimbursement.
If my location has a travel fee applied, I understand that this is not eligible for insurance reimbursement.
I am responsible for verifying my own lactation benefits. Montclair Lactation can only see that I have benefits, they cannot see if I have any special circumstances that might prevent my insurance provider from covering services. If my plan denies coverage of lactation services after the claims have been submitted, I am responsible to pay at the self-pay rate. I understand I should refer to my plan benefits and call my insurance directly to verify lactation coverage.
Montclair Lactation may communicate with my insurance company in reference to the services provided to me and my baby or babies. Montclair Lactation may communicate with my credit card company or bank for any payment related matters. It is my responsibility to provide accurate and current payment and insurance information. I will update my credit card information as needed and am responsible for any costs and fees associated with my failure to provide updated information.
These policies apply to Montclair Lactation and its representatives.
Cancellation policy: Your 90-minute appointment slot is reserved especially for you. If you need to cancel or reschedule your visit I ask that you please communicate with me in a timely manner. I choose not to charge a cancellation fee and rely instead on your thoughtful consideration for my time. Thank you.
For self-pay (out-of-network) clients, full payment is due at the time of the visit. Payments may be made by cash, check, Venmo, or Zelle. Montclair Lactation will provide a superbill suitable to submit to insurance for potential reimbursement. The superbill (which will also serve as a payment receipt) will be coded appropriately to the level of service provided during the visit.
Montclair Lactation is providing care to me and to my baby or babies; together we are all the client of Montclair Lactation. My initial visit includes 1 week of follow-up support by secure messaging, email, text, or phone. Continued support is available for a weekly fee of $40. These fees are elective and not eligible for insurance reimbursement.
If my location has a travel fee applied, I understand that this is not eligible for insurance reimbursement.
I am responsible for verifying my own lactation benefits. Montclair Lactation can only see that I have benefits, they cannot see if I have any special circumstances that might prevent my insurance provider from covering services. If my plan denies coverage of lactation services after the claims have been submitted, I am responsible to pay at the self-pay rate. I understand I should refer to my plan benefits and call my insurance directly to verify lactation coverage.
Montclair Lactation may communicate with my insurance company in reference to the services provided to me and my baby or babies. Montclair Lactation may communicate with my credit card company or bank for any payment related matters. It is my responsibility to provide accurate and current payment and insurance information. I will update my credit card information as needed and am responsible for any costs and fees associated with my failure to provide updated information.
These policies apply to Montclair Lactation and its representatives.
Cancellation policy: Your 90-minute appointment slot is reserved especially for you. If you need to cancel or reschedule your visit I ask that you please communicate with me in a timely manner. I choose not to charge a cancellation fee and rely instead on your thoughtful consideration for my time. Thank you.
