Fees & Insurance
An important note about upcoming changes:
At MilkMatters, we've always believed that having expert support can make all the difference. Our goal is to help families navigate feeding challenges with confidence and provide the guidance they need to meet their feeding goals.
To continue providing the personalized care and support our families value, MilkMatters will transition to a self-pay practice in September 2026 and will no longer bill insurance companies directly.
Please read the information below about your insurance company to learn more about what is changing and when.
Fees and Payment
Our standard fees are as follows:
$275 for a Prenatal Consult
$350 for an Initial Consult
$275 for Follow-up Consults
If you have multiples, there is fee for each additional child of $100 for the Initial Consult and $50 for Follow-up Consults.
We accept Venmo, credit and debit cards, HSA/FSA cards, and PayPal. We will provide you with a superbill receipt that you may use to seek reimbursement from your insurance. See insurance info below.
Guidance for Using Your Insurance
CDPHP
For visits scheduled through August 31, 2026, we are an in-network provider with CDPHP. We will submit the claim for you and CDPHP will pay us directly. Services are fully covered (no copay, deductible, etc.) for all plans, including CDPHP Medicaid.
For visits scheduled September 1, 2026 and after, we are not in-network with CDPHP. You will pay our standard fee, directly to us. We will provide you with a detailed receipt called a superbill, which you can use to request reimbursement.
It is best to call your insurance company and get official information from them, but we’ve learned from other clients that most CDPHP employer-sponsored plans will reimburse members in full for lactation services from an out-of-network provider. It seems Regeneron employee plans and Medicaid plans do not allow for reimbursement. The form to request reimbursement can be found here: https://www.cdphp.com/-/media/files/employers/lactation-reimbursement.pdf
United Healthcare
For visits scheduled through August 31, 2026, we are an in-network provider with most UnitedHealthcare plans, including Choice Plus plans. We are not in-network with The Empire Plan - see more about The Empire Plan below. A few Oxford plans require prior authorization and we can help with that process after you book and provide your insurance information on your intake forms.
Home visits and office visits are fully covered, but telehealth (virtual) visits are not covered. We will submit claims for both the parent and the baby, and UnitedHealthcare will pay us directly. If the parent and baby both have UnitedHealthcare, services are fully covered (no copay, deductible, etc.). If the parent has coverage and the baby does not, there is a $125 out-of-network child fee.
For visits scheduled September 1, 2026 and after, we are not in-network with UnitedHealthcare. You will pay our standard fee, directly to us. We will provide you with a detailed receipt called a superbill, which you can use to request reimbursement.
For The Empire Plan/NYSHIP, we have consistently seen our clients receive full reimbursement from their insurance for home visits and office visits. Telehealth is not reimbursed.
For all other plans, we do know know if you will be reimbursed by your insurance. We strongly encourage you to call your insurance before booking and ask if they will reimburse you for lactation services from an out-of-network provider.
MVP
MVP requires members to work with one of their telehealth Lactation Consultants before covering an in-person visit with an out-of-network provider. Look in your MVP member portal for information about Corporate Lactation Services or learn more here: https://www.mvphealthcare.com/members/resources/health-wellness/pregnancy-family
If you find the telehealth support available through MVP does not meet your needs, you may request that they cover care from us or another Lactation Consultant that you can meet with in person. They will typically cover in-person visits on a case-by-case basis after you’ve met with someone through their telehealth option. If MVP approves you to work with us, you will make payment to us and then get reimbursed from MVP.
Aetna
We are not in-network with Aetna. In the past, clients with Aetna have been reimbursed for our services, but we cannot guarantee you will be reimbursed for services in the future. In general, Aetna commonly assigns a portion of the cost to the member, which may be a copay or coinsurance, or might go toward your deductible.
Be sure to call Aetna and ask them whether you will be reimbursed for lactation services from an out-of-network provider before booking. Find out if they’ll reimburse you for the full amount you paid or if any cost-sharing will apply.
Blue Cross Blue Shield
There are many companies under the umbrella of Blue Cross Blue Shield and we are not in-network with any of them. We’ve seen some clients get reimbursed in full and others denied. With the Albany Med Highmark plan, we are consistently seeing clients get denied reimbursement, but we still encourage all clients to call and ask.
Call the number on your card and ask if you will be reimbursed for lactation services from an out-of-network provider before booking.
Cigna
Cigna uses a company called Wildflower to provide lactation services via telehealth and in person. We do not participate with Wildflower. To find a Lactation Consultant working with Wildflower, click here: https://www.wildflowerhealth.com/clients/patients
If you’d like to work with us, call the number on your card and ask if you will be reimbursed for lactation services from an out-of-network provider before booking.
What should I say when I call my insurance company?
Tell them you want to schedule an appointment with a Lactation Consultant and you want to know if it will be covered.
They might ask you for this information:
Procedure code: S9443 Lactation classes, non-physician provider, per session (This code is used for all visits, not just classes. It is the standard code use for all lactation services.)
Diagnosis code: Z39.1 Lactating parent
NPI: 1275185811
EIN/TIN/tax ID: 85-4289793
If they tell you that you will not be reimbursed because we are not in their provider network, ask:
Do they have any in-network lactation consultants who can come to your home or with an office near you?
If they don't have any in-network LCs, will they fully reimburse you for an out-of-network LC, at the full rate charged by the LC?
Do you need to obtain prior authorization?
What information do they need from you to obtain reimbursement? Is there a form?
If you plan to schedule a virtual consult, be sure to ask specifically about your coverage related to telehealth lactation support.
More information about legal requirements for insurance companies to cover breastfeeding support services can be found here.
I can’t find a Lactation Consultant who will take my insurance and I can’t afford to pay out of pocket. What can I do?
A great resource available to everyone, free of cost, is Baby Cafe. They offer virtual and in-person support groups where you can meet with other parents, and they also have professional lactation consultants on staff who can meet with you one-on-one if needed. There are multiple locations around the Capital Region. Learn more here: https://healthprograms.org/breastfeeding-support/baby-cafes/
If you qualify for WIC, ask to connect with a peer breastfeeding counselor or a Lactation Consultant. WIC can also help with getting a breast pump.
“Was very (pleasantly) surprised that my insurance covers unlimited visits.”