Please note:

In order to provide the comprehensive care our clients value, MilkMatters is a self-pay practice and does not bill insurance companies. Please read the information below about your insurance company to learn more.

CDPHP

We are not in-network with CDPHP, however you may be reimbursed by CDPHP for our services. You will pay our standard fee, directly to us. As a courtesy to our clients, we are happy to submit your reimbursement form to CDPHP along with supporting documentation on your behalf. We have heard from clients that they typically receive a check from CDPHP in the mail in 3-4 weeks.

It is best to call your insurance company and get official information from them, but we’ve learned 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. More information about calling your insurance can be found at bottom of this page.

The Empire Plan

NYSHIP

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.

You will pay our standard fee, directly to us. As a courtesy to our clients, we are happy to submit a claim to The Empire Plan and follow up with them as needed on your behalf. More often than not, these claims are processed incorrectly on the first try. We routinely check for these errors and request an adjustment from The Empire Plan when needed. Typically, our clients receive a portion of their reimbursement in 3-4 weeks, and the rest a month or so after that. Over the last 3 years, all of our clients with The Empire Plan have been reimbursed in full for all of their visits with us.

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. More information about calling your insurance can be found at bottom of this page.

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. More information about calling your insurance can be found at bottom of this page.

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. More information about calling your insurance can be found at bottom of this page.

Guidance for Calling your Insurance Company

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?

• 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.

Be sure to write down any information you receive and the reference number for your call. Additionally, you can ask that they email you the information so you have it in writing.

More information about legal requirements for insurance companies to cover breastfeeding support services can be found here.