Policies for Clients with United Healthcare Insurance

We have IBCLCs who are in-network providers for many UHC plans, except for marketplace plans and Medicaid plans.* To verify that we are in-network with your specific UHC plan, please login to your UHC account and search for “Lactation Specialists” in the "Find A Doc" section of the website. Please be aware that you may need to expand the mileage to a 50-mile radius to find us.

To find out your specific benefits, please contact UHC directly.

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.

Please read this document from Aetna explaining the difference between an in network and an out of network provider.

If either patient (lactating parent or baby) does not have coverage through UHC or another insurance we are in network with, you will be charged a fee per non-covered patient for each standard visit

Due to insurance reimbursement rates, we bill your insurance for both the lactating parent and baby(ies) at each visit. For those patients who do not have in network insurance coverage for either the lactating parent or the baby you will be responsible for paying a non-covered patient fee.    A superbill can be provided for submission to the other insurance company for reimbursement purposes.

If your policy applies a co-pay, co-insurance or deductible, you will be responsible for paying for these charges.

Usually, services are covered at 100% under the mother, but sometimes there is a deductible, co-pay or co-insurance. These charges most commonly apply to baby; however, they may occur on mom in some plans.

Please contact UHC to find out if your services will be subject to a deductible, copay or coinsurance. When speaking with them, you can reference the codes we use for our services.

• Codes:  s9443 and 98960

PLEASE NOTE THAT UHC DOES NOT COVER TELEHEALTH SERVICES FOR LACTATION.  IF YOU CHOOSE A TELEHEALTH VISIT, YOU WILL BE CHARGED OUR SELF-PAY RATE FOR YOUR VISIT.

Understanding co-pays, co-insurance and deductibles

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

Some UHC plans restrict coverage for lactation services.   Examples of these plans include non-ACA compliant plans, self-funded plans, and grandfathered plans and plant that do not fall under the ACA guidelines.   If you are in one of these plans, your lactation visit may not be covered by UHC. 

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

Currently, we are aware that all HMO plans require referrals.

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 UHC 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 UHC, regardless of your plan.  If we know that a fee will not be covered, these fees will be billed to the patient.  Examples of non-covered services include the Home Visit Trip/Convenience Fee or a late cancellation or no-show fee.

If you have chosen to have a home visit, our standard trip fee/convenience surcharge will be charged to your credit card following your visit.  This fee is NOT billed or covered by insurance.

We are in network with several other insurance companies including:

• Aetna
• BCBS
• Sana Health
• We can not guarantee that your insurance provider will cover our services.

We require that all patients provide a credit card prior to the initial visit.  We will not schedule your appointment without having a credit card on file

• You are authorizing us to save your card in your file and use it to pay the following fees:
• Late cancellation or no-show fees 
• Home Visit Trip / Convenience fee 
• Co-Pay, co-insurance, deductibles or services that are not covered or denied. 
• Non-covered services
• Fees for non-covered patient