Payment and Insurance

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Insurance Coverage

Aetna, UMR, and United Healthcare

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.

CIGNA

Aetna, UMR, and United Healthcare

Currently we are able to submit to CIGNA for coverage of lactation visits but considered out of network. Depending on plan, payment may be due at the time of the visit. Please keep in mind we are out of network and they may not cover any cost.

NYSHIP

Aetna, UMR, and United Healthcare

BCBS, Excellus, Highmark, and Anthem, and cards with Multiplan logo

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 keep in mind we are out of network and they may not cover any cost.

BCBS, Excellus, Highmark, and Anthem, and cards with Multiplan logo

Payment is due at the time of the service and we will then submit the visit to insurance for possible reimbursement. Patients with these plans will expect to receive a check from the insurance plan for reimbursement and the difference in the paid amount from insurance and the amount you paid at the time of the visit will be the amount due for the remainder of the payment.

Other Insurance Plans

BCBS, Excellus, Highmark, and Anthem, and cards with Multiplan logo

Medicaid and Fidelis Beneficiaries

For any other insurance plans not mentioned here, we expect payment at the time of service. We can provide you a superbill to submit to your insurance as there are quite a few plans that do not cover visits. MVP is one of those plans that will not reimburse for out of network visits.

Medicaid and Fidelis Beneficiaries

BCBS, Excellus, Highmark, and Anthem, and cards with Multiplan logo

Medicaid and Fidelis Beneficiaries

Lactation visits are not covered at this time outside of a Dr's office or hospital. 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 discounted office visits. Payment plan can also be discussed if needed. We can help assist you in finding help in our area if needed.

Visit Cost

Initial Appointment

At the initial appointment we review your medical history, current questions and concerns, and examine the infant's mouth, sucking patterns, and latch onto a breast or bottle. We then make a plan on how to improve your feeding journey. If you are wondering if we could be of assistance to you please contact us as there are many reasons to see a lactation consultant even if you are exclusively bottle feeding as we work on infants with latching difficulties with breast milk or formula.

In-Person Office 120 minute Multiple Infant's Initial Appointment

$225

This visit is for both parent and multiple infants or tandom feeding a toddler and infant.

In-Person Office 90 minute Parent and Infant Initial Appointment

$200

This visit is to address concerns for both the lactating parent and infant

In-Person Office 60 minute Parent only or Infant only Initial Visit

$125

This visit works well for working on infant bottle refusal, latching concerns, or if the lactating parent is having pain or questions regarding pumping. This visit is to focus only on one member of the family and not the dyad.

Telehealth 120 minute Multiple Infant's Initial Appointment

$200

This visit is for both parent and multiple infants or tandom feeding a toddler and infant.

Telehealth 90 minute Parent and Infant Initial Appointment

$175

This visit is to address concerns for both the lactating parent and infant

Telehealth 60 minute Parent only or Infant only Initial Visit

$90

Follow Up Appointment

This appointment can be for follow up after a Prenatal or Initial appointment or to work on any concerns that arise throughout the journey including pumping questions, returning to work, bottle refusal, introducing solid foods, masitis, plugged ducts, medication risks and safety, weaning, and much more.

In-Person Office 120 minute Multiple Infant's Follow-Up Appointment

$190

This visit is for both parent and multiple infants or tandom feeding a toddler and infant.

In-Person Office 90 minute Parent and Infant Follow-Up Appointment

$175

This visit is to address concerns for both the lactating parent and infant

In-Person Office 60 minute Parent only or Infant only Follow-Up Visit

$100

Telehealth 120 minute Multiple Infant's Follow-Up Appointment

$175

This visit is for both parent and multiple infants or tandom feeding a toddler and infant.

Telehealth Office 90 minute Parent and Infant Follow-Up Appointment

$150

This visit is to address concerns for both the lactating parent and infant

Telehealth Office 60 minute Parent only or Infant only Follow-Up Visit

$75

In-Person Weight Check or Tongue Check

$30

This is a quick 15 minute appointment to monitor weight gain or to monitor infants healing after a Tongue/Lip/Buccal Tie procedure.

All visits include 1 week of follow up via secure messaging within our Electronic Medical Record, e-mail, or phone follow up. This price also includes the $15 billing fee for insurance submissions. Please call to ask about pricing for Fidelis and Medicaid patients.

Payment

Payment and Super Bill:

Full payment is due prior to the time of service if you do not have Aetna or United Health Care, unless a prior payment plan has been made, no matter the type of insurance reimbursement you may receive. Checks, cash, cash app, 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 you will not be charged a cancellation fee. 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. Some insurances will also reimburse for telehealth. Calling your insurance company to ask about "gap authorization" or pre-approval may be beneficial if you have no in-network IBCLC's in our area. If you plan to do this it may take up to a week (sometimes longer) for the authorization to process. This may not cover the full cost of care. If you call your insurance plan please duscuss with them what the reimbursement rate for care will be for out of network and what the length of approval will be. They may request the following information in order for you to apply for the exception:

Whitt's End, RN PLLC NPI: 1700527363

Diagnosis Code: Z39.1 (care and exam of lactating mother)

Procedure Code: 99403, 99404, S9443

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

Insurance Coverage

Aetna, UMR, and United Healthcare

Aetna, UMR, and United Healthcare

Aetna, UMR, and United Healthcare

CIGNA

Aetna, UMR, and United Healthcare

Aetna, UMR, and United Healthcare

NYSHIP

Aetna, UMR, and United Healthcare

BCBS, Excellus, Highmark, and Anthem, and cards with Multiplan logo

BCBS, Excellus, Highmark, and Anthem, and cards with Multiplan logo

BCBS, Excellus, Highmark, and Anthem, and cards with Multiplan logo

BCBS, Excellus, Highmark, and Anthem, and cards with Multiplan logo

Other Insurance Plans

BCBS, Excellus, Highmark, and Anthem, and cards with Multiplan logo

Medicaid and Fidelis Beneficiaries

Medicaid and Fidelis Beneficiaries

BCBS, Excellus, Highmark, and Anthem, and cards with Multiplan logo

Medicaid and Fidelis Beneficiaries

Visit Cost

Prenatal Appointment

In-Person Office Prenatal Appointment

Virtual Prenatal Appointment

Initial Appointment

In-Person Office 120 minute Multiple Infant's Initial Appointment

In-Person Office 90 minute Parent and Infant Initial Appointment

In-Person Office 60 minute Parent only or Infant only Initial Visit

Telehealth 120 minute Multiple Infant's Initial Appointment

Telehealth 90 minute Parent and Infant Initial Appointment

Telehealth 60 minute Parent only or Infant only Initial Visit

Follow Up Appointment

In-Person Office 120 minute Multiple Infant's Follow-Up Appointment

In-Person Office 90 minute Parent and Infant Follow-Up Appointment

In-Person Office 60 minute Parent only or Infant only Follow-Up Visit

Telehealth 120 minute Multiple Infant's Follow-Up Appointment

Telehealth Office 90 minute Parent and Infant Follow-Up Appointment

Telehealth Office 60 minute Parent only or Infant only Follow-Up Visit

In-Person Weight Check or Tongue Check

Payment

Payment and Super Bill:

Insurance Coverage

Aetna, UMR, and United Healthcare

Aetna, UMR, and United Healthcare

Aetna, UMR, and United Healthcare

CIGNA

Aetna, UMR, and United Healthcare

Aetna, UMR, and United Healthcare

NYSHIP

Aetna, UMR, and United Healthcare

BCBS, Excellus, Highmark, and Anthem, and cards with Multiplan logo

BCBS, Excellus, Highmark, and Anthem, and cards with Multiplan logo

BCBS, Excellus, Highmark, and Anthem, and cards with Multiplan logo

BCBS, Excellus, Highmark, and Anthem, and cards with Multiplan logo

Other Insurance Plans

BCBS, Excellus, Highmark, and Anthem, and cards with Multiplan logo

Medicaid and Fidelis Beneficiaries

Medicaid and Fidelis Beneficiaries

BCBS, Excellus, Highmark, and Anthem, and cards with Multiplan logo

Medicaid and Fidelis Beneficiaries

Visit Cost

Prenatal Appointment

In-Person Office Prenatal Appointment

Virtual Prenatal Appointment

Initial Appointment

In-Person Office 120 minute Multiple Infant's Initial Appointment

In-Person Office 90 minute Parent and Infant Initial Appointment

In-Person Office 60 minute Parent only or Infant only Initial Visit

Telehealth 120 minute Multiple Infant's Initial Appointment

Telehealth 90 minute Parent and Infant Initial Appointment

Telehealth 60 minute Parent only or Infant only Initial Visit

Follow Up Appointment

In-Person Office 120 minute Multiple Infant's Follow-Up Appointment

In-Person Office 90 minute Parent and Infant Follow-Up Appointment

In-Person Office 60 minute Parent only or Infant only Follow-Up Visit

Telehealth 120 minute Multiple Infant's Follow-Up Appointment

Telehealth Office 90 minute Parent and Infant Follow-Up Appointment

Telehealth Office 60 minute Parent only or Infant only Follow-Up Visit

In-Person Weight Check or Tongue Check

Payment

Payment and Super Bill:

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