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We are now In-Network with Aetna, UMR (Tier 3 with Guthrie), and United Healthcare (Most commercial/employee plans) and able to submit visits for coverage of lactation visits.
Currently we are able to submit to CIGNA for coverage of lactation visits but considered out of network.
Currently we are able to submit to NYSHIP for coverage of lactation visits. Patients with NYSHIP will expect to receive a check from the insurance plan for reimbursement and that amount is what will be expected for payment.
Please fill out this form prior to scheduling for insurance approval. Once approved you may have up to 6 visits covered in full. If not approved, we will have you pay the self pay fee at the time of the visit and submit the visit to insurance for reimbursement.
For now, we are submitting to most insurance companies to see who is reimbursing. We request that you pay the self pay amount until we figure out what is covered. Reimbursement is determined by your insurance company and is not guaranteed. We are in the process of becoming in-network with a few of the larger insurance companies. Stay tuned!
Lactation visits are not covered at this time. Please call our office to schedule as a photo of your insurance card or WIC coverage is required. Medicaid and WIC beneficiaries may be eligible for office visits at 50% off. Payment plan can also be discussed.
Full payment is due prior to the time of service if you do not have Aetna, CIGNA, NYSHIP, or approved with TLN (the lactation network) unless a prior payment plan has been made, no matter the type of insurance reimbursement you may receive. Checks, cash, and all major credit cards (including HSA/FSA account cards) accepted. If needing to pay with cash, please call the office at 607-738-2091 to arrange. If your check does not process a $15 fee will be added.
If the visit is cancelled prior to 24 hours, your fee will be reimbursed. If your visit is cancelled within 24 hours prior to the visit, there will be a $25 cancellation fee. No cancellation fee for Snow Days or inclement weather.
We can either submit to the insurance company directly or can give you a form (superbill) to submit to your insurance provider for potential reimbursement of the cost of the visit. Reimbursement is not guaranteed and depends on your insurance and plan. With COVID, some insurances will also reimburse for telehealth. Calling your insurance company to ask their policies and to submit for pre-approval may be helpful.
Please let them know your visit with me is urgent and request a rush on the process. The billing company I use will be the ones in contact with your insurance company. This includes writing letters, talking on the phone, or submitting any paperwork.
Lactation *should* be covered according to the Affordable Healthcare Act. Please see this
document for more information about when breastfeeding is covered: https://nwlc.org/wp-content/uploads/2015/08/nwlc_breastfeedingfactsheet.pdf