Lactation Coverage for Curative in Houston and San Antonio

An in-network provider has a contract with your insurance company and agrees to provide services at a contracted rate, which is usually discounted.  An out of network provider does not have a contract with your insurance company and may charge any rate for their services.  Some plans cover out of network providers and other require you to see an in network provider. 

If mom and baby have different insurances, we will submit a claim on each patient.

Generally, as long as lactation is covered under your plan, there will be no out of pocket costs for your lactation visit.

Yes, however, you will incur a $70 travel fee for each home visit.  

• Home Visit Codes: 

• Mom: 99404 + S9443. Diagnosis Z39.1 

• Infant: 99404 + S9443. Diagnosis R63.3 or Z71.89

If our services are not covered by Curative, you will be responsible for paying for them out of pocket, but we will offer a timely payment discount.  

Some Curative plans restrict coverage for lactation services. Examples of these plans include:  

• Grandfathered plans 

If you are in one of these plans, your lactation visits may not be covered by Curative.  

Some Curative plans require a referral or precertification, and we recommend checking with Curative to see if this applies to your plan. 

If you are in one of these plans, you need to get a referral from your PCP and the baby’s PCP prior to your first visit, or the services may not be covered. 

If our claim is denied by Curative because the services require a referral or pre-certification, and the referral or pre-certification was not obtained prior to your visit, you will be responsible for paying for these services out of pocket, but we can offer a timely payment discount. 

There are some fees that are not covered by insurance, regardless of your plan. If we know that a fee will not be covered, this fee will be billed to the patient. Examples of non- covered services include but are not limited to:  

• Home Visit Travel Fee
• Late Cancellation/ No Show Fee 
• Non-covered service, such as chiropractic care or laser photobiomodulation treatments

We require that all patients have a valid card on file to secure the booking of their initial visit. We will not schedule your appointment without having a valid card on file.  

You are authorizing us to save the card on file and use it to process the following fees:  

• Late cancellation / no show fees 

• Home Visit Travel Fee 

• Copay/ Coinsurance / Deductible 

• Non covered / denied services 

• Non covered patient fee for mom or baby who does not have billable insurance