Using your Insurance for Lactation Support
Looking for insurance covered lactation support in Baltimore, MD?
You’ve come to the right place! We accept most major insurance plans.
Did you know most insurance plans cover lactation visits with no cost to you? Prenatal, postpartum, weaning, back to work - you can use your insurance for them all! Thanks to the Affordable Care Act, lactation services are considered preventive care, and therefore are (usually) covered 100% by your insurance plan. If you have a plan that was enacted pre-2008, you may not have mandated lactation coverage.
Here’s more information about the plans we are in-network with.
CareFirst
Most CareFirst plans allow for unlimited lactation support at no cost to you!
We bill CareFirst plans in Maryland directly, as well as out-of-state plans that are included in the national network partnership (BlueCard program).
If you have an out-of-state plan, and your card has a suitcase on the front, you are eligible to work with us through the BlueCard program. Carefirst covers virtual and in-person visits.
Some plans limit the number of visits you can have, or may apply a co-pay.
We can bill the following Carefirst Plans: Carefirst of Maryland, Carefirst BlueChoice Provider Networks, EPO, PPO, HMO, FEP, BluecrossBlueshield, Anthem, any plan in the BlueCard national program.
Cigna
We bill Cigna directly through a vendor called Wildflower (this is who you will see on your Explanation of Benefits).
They guarantee that your plan covers everything 100%.
They cover virtual or in-person visits, on an unlimited basis.
We can bill any plan in the Cigna network, including local plans that are contracted through Cigna networks.
Aetna
Aetna covers lactation with some limits. They track these visits based on the billing code S9443, and some plans only allow six uses of this code.
Unfortunately, that code gets used twice for one visit when we see you AND baby at the same time. That means that you may only have coverage for 3-6 lactation visits.
Another thing to consider is that if you took a prenatal lactation class (with us or through Areoflow), one of those codes has already been used up. Of course, the world of insurance is vast and confusing, so it is always best to call your insurance provider to ask “how many S9443 codes do I have available?”.
Once the codes are used up, Aetna will bill lactation visits through your deductible/copay/coinsurance, as applicable. We will also bill other codes during a visit (depending on the type of visit). These may go to deductible/coinsurance as well. We will look up an estimate for each visit, and let you know the anticipated charges.
We can bill the following Aetna plans: HMO, PPO, EPO, POS, QPOS, Elect Choice, Open Choice, Managed Choice POS, Aetna Choice POS II, Aetna Select, Aetna Student Health, indemnity plans with network incentives, Aetna Signature Administrators®, Joint Claims Administration, Meritain/Meritain Shared Administrative Services, Passport to Healthcare® and National Advantage Program plans. If your insurance has access to the national Aetna network, we can see you.
United Healthcare
Most United Healthcare plans cover unlimited lactation visits in-person! Some plans restrict virtual coverage. We can look this up prior to booking with you. We will check that we are in-network with your plan prior to booking.
We can bill the following UHC plans: United Healthcare, Optimum Choice, Inc., Oxford Health Insurance, Inc., Oxford Health Plans (NJ), Inc., Oxford Health Plans (CT), Inc., All Savers Insurance Company, or other affiliates.
What about Medicaid?
In Maryland, Medicaid only allows IBCLCs who are also licensed doctors (MD), nurse midwives (CNM), or nurse practitioners (NP) to be credentialed with them. While we are also IBCLCs, we do not carry any of those licenses, just an RN license! Therefore, we are not covered with Medicaid to provide lactation services due to our licensure level. At Wild Fig Lactation, we do offer sliding scale payment options if you are covered with Medicaid and looking for support.
What do I need to do?
When you reach out to work with us, you will upload your insurance card. We will then verify that your plan is active, and let you know if we see any restrictions on our end. From there, we take care of the rest. We anticipate that all services will be covered 100%, but there are some unique plans out there that restrict lactation and preventative coverage.
If you want peace of mind…
We always suggest reaching out to your insurance provider directly to find out if lactation services will be covered.
You can tell them you are working with Wild Fig Lactation, an in-network provider in the state of Maryland (EIN 99-0821158).
You can ask if your plan covers the following codes: S9443, 99404, 99344 for Mom, and 99404, S9443 for baby.
Ask if these codes are allowed with no out-of-pocket cost.
Make sure you know if telehealth is covered or just home visits.
What if I get an EOB saying I owe?
Many plans incorrectly process claims, and we will always call to get them reprocessed. If you ever have questions, reach out to us. We do our best to communicate charges prior to our visit, and will appeal if necessary.
What if I don’t have insurance or a different insurance company?
Reach out to us anyway! We offer self-pay rates and payment plans.
