Plans for Lactation Insurance Coverage

Billing through insurance does not guarantee 100% coverage. Your plan may apply a co-pay, cost sharing or deductibles. We always encourage you to contact your insurance company prior to services to clarify any questions regarding your specific coverage options.

We work closely with the breastfeeding parent and the baby in most of our consults. Our assessments and care plans are focused on creating a successful plan for the parent and the baby. Please note in the case of supporting the dyad (parent and baby) there will be 2 separate claims submitted through insurance.

* Some United Health Care plans are not allowing Lactation Care to be covered under codes S9443 and diagnosis code Z39.1 for the parent and baby, please contact your specific plan prior to your visit to clarify your coverage with the use of these codes. The cost of the consult will be requested if the claim is denied by your insurance plan.

** If you have used any of your alloted consults through other organizations prior-to-or-after delivery there may be a denial of your Lactation Room claim from your insurance. A claim will be filed for you and your baby if both of you are involved in care and there may be a copay or cost-sharing applied by your insurance for one or both patients even if the Aetna representative states these are “free” services. This is not accurate information. Please confirm how many eligible consults your plan provides if you have any concerns or questions.

Cigna Plans

1. Lactation Room is out of network with Cigna but we will submit a request for a pre-authorization for a “Special Exception” or “Gap Exception” for coverage. This is an attempt for Lactation Room to get you pre-approval for services to help eliminate any out of pocket fees.

• We will file the claim for our Cigna families as a courtesy.
• If the direct payment from Cigna does not cover the self-pay fee ($250) we will invoice you for the balance due. If the payment received from Cigna covers the out-of-network fee then there is no out of pocket expense for our families.
• Please call 301-529-5433 for more information if necessary.

*** Please note, CIGNA is stating Lactation Room is in-network however, we are not. This is an error on their Claims side of the company. We’ve been working with them to get this error corrected ***

All other Out-of-Network Insurance Plans

Please call your insurance and request a “Special Exception” or “Gap Exception” for lactation coverage. Provide them with the following information:

Administrative address: 8730 Mapleville Road, Mount Airy, 21771

• NPI: 1033576202; EIN: 811147101
• Procedure Code 99404 and S9443
• Administrative address: 8730 Mapleville Road, Mount Airy, 21771
• Fax Number: 301-942-0030

This will help you with reimbursement. We will provide you with a superbill to provide to your insurance for reimbursement for self pay fees. The Affordable Care Act mandates insurance coverage for location services.

Insurance Reimbursement

Lactation Room is a private practice and fee is due at the time of service via credit card, cash, check or Flex Care Spending Accounts. Under the Affordable Care Act (ACA) lactation consultations may be covered by your insurance company, however there may be exceptions, cost-sharing, deductibles and copays applied by your insurance, so please check with your insurance provider for information per your insurance plan.

You will be provided with a coded invoice with the medical billing information necessary to assist with reimbursement, if your plan provides coverage. Flex Care Spending Accounts Visas are accepted as forms of payment.

Please contact Lactation Room for further information with possible insurance coverage options.