1. How many lactation appointments are covered?

UHC allows as many visits as medically necessary. There is no set visit limit.

2. Which UHC plans are covered?

✅ Most PPO, EPO, and POS plans are covered

✅ Some HMO plans are also covered, be sure to check all HMOs, along with all Navigator, Core, Nexus, and Doctor’s network plans (as shown on the card in the lower right-hand side)

❌ Plans not covered include:

● UHC Signature Value HMO

● UHC Individual Exchange Plans

● Any UHC Medicaid or Medicare plans (ex. Neighborhood Health, Community Health)

● UHC Oxford Metro

● UHC Heritage

If you're unsure about your plan, please email office@deeplylatchedlactation.com

3. Will I have any cost-sharing with UHC?

Because UHC views lactation as preventive care, most patients have:

● No cost-sharing, or

● A very minimal copay, typically $20 or less

If your cost-sharing is more than $20, contact Patient Relations and we’ll help you understand

your plan and see if we can work with you on a reconsideration

1. How many lactation appointments are covered?

Aetna covers six (6) visits under CPT code S9443 (lactation class code). These visits are

typically fully covered, but some policies may apply deductible or cost-sharing under specific

circumstances, particularly for baby if the family deductible will not be met by the birth.

2. Which Aetna plans are covered?

✅ Most PPO and EPO plans are covered.

❌ HMO plans are usually not covered, and Aetna does not grant network exceptions.

3. Will I have any cost-sharing for lactation visits with Aetna?

Usually not at first—but after three visits, some plans may incorrectly deny CPT code S9443,

resulting in $71.50 cost-sharing as they count 6 CPT codes rather than 6 dates of service per

an internal policy. If you go through the following steps, Aetna nearly always covers 6 dates of

service.

We recommend:

● Calling Aetna to request a reconsideration

● Filing a formal grievance if needed

● Contacting Patient Relations for help or to do a three-way call. Unfortunately, we cannot do the reconsideration from our end with Aetna, but we’re here to support you!

4. Why don’t my visits show up in the Aetna portal right away?

We hold Aetna claims for about 8 weeks post-birth so that delivery-related claims are processed first and your family deductible is met before lactation is billed.

5. What happens after 6 visits?

You may continue to be seen, but visits will include:

● $143 in cost-sharing for parent and baby

● Your specialist copay or coinsurance

1. How many lactation appointments are covered?

Coverage depends on the specific plan. Some BCBS plans fully cover lactation; others do not

cover lactation at all. If lactation is not covered, you can still be seen and will pay the

contracted rate. BCBS allows as many visits as medically necessary. There is no set visit

limit.

2. Which BCBS plans are covered?

✅ Most PPO plans are in-network and often cover lactation

✅ Select EPO plans are also in-network

❌ Most HMO plans are not in-network

✅ Anthem PPO, Regence PPO, Premera PPO and Federal Employee Plans (Basic,

Standard, PPO) are almost always covered for lactation

❌ Plans that are always out of network:

● Regence Legacy

● Blue Shield of California metal-tier plans (Bronze, Silver, Gold, Platinum)

3. Will I have any cost-sharing with BCBS?

If lactation is covered:

● You may have copays of $10–$40, or

● No cost-sharing at all, especially if you’ve met your deductible

If lactation is not covered:

● You’ll be billed the contracted rate of $175 in addition to other cost sharing assigned by

insurance for the lactating parent

● With financial assistance, this can be reduced to $125 for the lactating parent

4. How can I check if my BCBS plan covers lactation?

Call your insurance and ask:

“Do I have in-network coverage for CPT code S9443 with diagnosis Z39.1, billed in

a professional (not facility) setting?”

Ask for a call reference number—this helps hold the plan accountable.

If you're unsure or the representative is confused, contact Patient Relations to help and expect

2-3 business days for a lactation coverage check.

1. How many lactation appointments are covered?

Cigna allows as many visits as medically necessary. There is no set visit limit.

2. Which Cigna plans are covered?

✅ All Cigna commercial plans are covered

❌ HMO plans should be confirmed with Patient Relations

❌ Cigna Allegiance has some restrictions (see below)- Cigna Allegiance plans are clearly

marked with “Cigna Allegiance” on the insurance card - ❌ Telehealth is not covered,

❌ Baby is not covered

→ Baby’s portion will be billed at $150, or $125 with financial assistance

3. Will I have any cost-sharing with Cigna?

No.

Cigna plans have no cost-sharing, except for the infant on Cigna Allegiance plans ONLY .

If you are ever billed in error, or see unexpected charges, please contact Patient Relations.

4. How can I apply for financial assistance for Cigna Allegiance baby

billing?

● The Financial Assistance Form is included in all new intake emails

● You can fill it out before or after the appointment

● It reduces the baby’s charge from $150 to $125

We are able to bill ChampVA with no cost sharing.

Unfortunately, Medicaid does not allow IBCLCs to be in network at this time. We have a discounted cash pay rate for office and telehealth visits.