Services

MedCity Community Lactation Center offers insurance coverage for visits. We are continuing to work on expanding our insurance contracts. We are in-network with the following plans: Aetna, America’s PPO, Cigna, Curative Health, First Health, HealthEZ, Imagine Health, Medica (commercial and medicaid plans), Meritain, Multiplan, PNOA, United Healthcare, UHC UMR, VA CCN Optum East, Velocity PPO.

Some insurance plans are administered through our third-party partners, Wildflower Health and The Lactation Network (“TLN”). Eligibility for coverage through these programs must be verified directly through the links below prior to your appointment.

If you have Cigna insurance, use this link to check your eligibility: https://portal.wildflowerhealth.net/affiliate-care/6ca2166

If you have any of the following plans, use this link to check eligibility:
https://go.lactationnetwork.com/MedCityCommunityLactationCenterPLLC

Insurance Coverage Disclaimer

Under the Affordable Care Act (ACA), many health insurance plans cover preventive lactation support services without a deductible, co-pay, co-insurance, or other out-of-pocket expense. However, not all insurance plans are subject to these requirements, and coverage varies based on the insurance company, plan type, and individual policy. Preventive lactation services generally include education, routine support, and a check-up when the parent and infant are not experiencing a current breastfeeding or feeding problem. Examples may include prenatal breastfeeding education, routine latch or feeding education, and a general assessment to confirm that breastfeeding is progressing well.

When a parent or infant is experiencing a breastfeeding, pumping, milk-supply, breast, nipple, oral-motor, bottle-feeding, weight-gain, or other feeding-related concern, the visit is considered problem-focused medical care rather than preventive care. In these situations, applicable co-pays, co-insurance, deductibles, or other patient responsibility may apply according to the terms of your specific insurance plan.

We recommend contacting your insurance company directly before your appointment to verify your lactation benefits. Eligibility, coverage, and reimbursement are determined by your insurance plan, and we cannot guarantee how a claim will be processed or paid.

Clients are responsible for all applicable cost-sharing required by their insurance plan, including co-pays, co-insurance, deductibles, and any other patient responsibility identified by their insurance company.

Parent and Infant Claims

For most lactation visits, a separate insurance claim will be submitted for both the parent and the infant. Insurance companies require the parent and infant to be treated as separate patients, with separate medical records, assessments, diagnoses, documentation, and claims, even when they are seen together during the same appointment.

A claim will be submitted for only one patient when care is provided exclusively to that individual. For example, if the visit is solely for a parent’s pumping-related concerns and the infant is not assessed or treated, only a parent claim will be submitted. Likewise, if the visit is solely for an infant concern, such as bottle refusal, and the parent is not assessed or treated, only an infant claim will be submitted.

Because the parent and infant claims are processed separately, your insurance company may assign separate co-pays, co-insurance, deductibles, or other patient responsibility to each claim. Clients are responsible for any cost-sharing required by their insurance plan for each claim submitted.

Out-of-Network Insurance

If MedCity Community Lactation Center is not in network with your specific insurance plan, the self-pay rates for each service are listed below. After your visit, we can provide you with a superbill that you may submit to your insurance company as an out-of-network claim for possible reimbursement. Full or partial reimbursement is not guaranteed and depends entirely on your insurance plan’s out-of-network benefits, coverage requirements, and reimbursement policies.

All self pay fees must be paid at the time of service. Cash, check, credit card, FSA, and HSA are accepted. Please contact us if you have a financial need, as we are willing to work with your family.

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Common issues we see:

Comprehensive Consultation- During our first meeting, we will discuss your lactation experience and problem solve any issues that have come up. Typically, the meeting will last 90 minutes. We will discuss the parent and baby’s medical history, go through details of baby’s feeding patterns and any issues, complete a detailed oral motor assessment, check latch and watch a full feeding (if possible), check baby’s weight, and develop a care plan together for your family. If you are using a pump, we can check your flange fit and settings. $200

Follow Up Visit- Any visit after our first meeting to assess how things have been progressing and make adjustments to our plan as needed. This meeting will typically last about 45-60 minutes. $150

Prenatal Visit- A 60 minute one-on-one session to discuss feeding goals, examine medical history and past feeding experiences, and answer any questions that you have about breastfeeding. During this visit we can do a breast exam, measure you for flange sizing, practice hand expression (if you are over 36 weeks), discuss breast pump options to help with your selection, and provide you with a pump prescription if needed. Great for first time or experienced parents who have struggled with feeding issues with their previous children. We highly recommend completing our online breastfeeding education course prior to our 1:1 prenatal visit. The link to our online breastfeeding course is under the Classes & Support Groups tab. $100

Pump Fitting and Education Visit- A 30 minute session for our pumping families to check pump settings and flange fit. During the visit, we will measure you, trial different sizes of flanges, and trial different flange shapes to get your most comfortable fit. We carry flange sizes 10-22 mm and various shapes- standard, crater, pano, and saucer. Education will be provided on how to optimize and maintain milk supply. This visit includes a set of flanges for you to keep. $75

Induced Lactation and Relactation Visit- For families looking to breast/chestfeed an adopted baby for the first time or to relactate for a biological or adopted baby. Length of appointment and fee dependent on specific needs. Typically a 1 to 2 hour appointment. $150-200

Virtual Visits- Virtual visits are available at the discretion of the medical provider Some issues such as weight gain, latching difficulty, etc. are best served via in-person appointments only. Call for further details. Initial- $125, Follow Up $100

Home visits are available for special circumstances for an extra fee. Please reach out to us to discuss the details.

Scale rental available on a limited basis for established clients.