Insurance Coverage

  • I am contracted with Wildflower Health to provide lactation care at no cost to Cigna subscribers. They guarantee 100% coverage on their lactation visits! Easy!

  • Aetna limits the use of one specific billing code (s9443) for lactation visits. Some plans only cover 6 uses of this code (one visit may use the code twice for mom & babe). You can call and ask how many uses of the code S9443 with diagnosis code Z39.1 you have. If you did any online lactation courses prenatally, it may have used up some of your codes. However, we are able to bill other codes. We will provide an estimate of any balance due prior to your appointment. If someone told you you get “6 free visits” its not always that simple. We wish it were!!

  • Most plans allow unlimited home visits at no out of pocket cost to you. Virtual care may not be covered. Check with your individual plan.

  • Some employers offer an Health Savings Account with high deductible plans. This money can used 100% toward lactation care. I do not need to be in network with your insurance to swipe your HSA card.

  • If you have BCBS, Medcost or another plan that is not listed above, we can provide you with a superbill! This is basically an itemized receipt for the services we provide you. You can submit this to your insurance for possible reimbursement. We require payment prior to the appointment.

  • Unfortunately, Medicaid does not allow Lactation Providers to be in-network. We are working to change that at the state level! In the meantime, we offer a discounted rate for out-of-pocket care ($75 a visit). Please go ahead and submit an appointment request and include your medicaid ID.

Thanks to the Affordable Care Act, lactation services are considered preventive care, and therefore SHOULD be covered 100% by your Insurance Plan

Reach out to your insurance provider directly

In-Network? Find out if lactation services are covered

  • Tell them you are working with Milkweed Lactation, an in-network provider, in the state of North Carolina (NPI )

  • You can ask if your plan covers the following code S9443

    • other codes may be billed such as 99404, 99344, 98960 depending on visit, but s9443 will always be used.

  • Ask if these codes are allowed with no out-of-pocket cost. 

  • Make sure you know if telehealth is covered or just home visits.

Out-Of-Network?

  • Call prior to booking to find out if your insurance company will provide a “Network Gap Exception” to work with Milkweed Lactation.

  • If there is no lactation provider (IBCLC) in your area that is within a reasonable distance they may grant out-of-network coverage via a Network Gap Exception.

  • Tell them you are working with an IBCLC who is also an RN. Tell them diagnosis code z39.1 and CPT code S9443 will be billed.

  • After your visit with me I will provide you with a Superbill with the above information. Submit this to your insurance company.

  • You should be reimbursed in a few weeks.

My insurance company sent me a bill or did not reimburse me?!

  • Remind them that the Affordable Care Act mandates that preventative services are covered 100%, and lactation services are considered preventative care.

  • The National Women’s Law Center provides information, scripts and form letters to appeal a bill or denial for lactation coverage. Click HERE

  • Let me know so I can help you navigate the process.