INSURANCE & COVERAGE
How to maximize your benefits and request reimbursement
How Insurance Works for Your Consultation
Learn how to maximize your benefits and get the support you deserve.
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1 – Our Current Insurance Status
We are proudly In-Network with Cigna (via Wildflower Health).
For other major insurance companies in Florida (such as Florida Blue, Aetna, and UnitedHealthcare), we are currently in the process of becoming In-Network providers. In the meantime, we operate as an Out-of-Network practice for these carriers. This means you pay for the service at the time of your visit, and we provide you with a detailed Medical Superbill (a specialized receipt with medical codes) that you can submit to your insurance for reimbursement.
[Click here] to instantly check your Cigna eligibility and coverage.
2 – Understanding Your Plan (PPO vs. HMO)
Your reimbursement success depends on your specific plan type:
- PPO & POS Plans: These usually have “Out-of-Network Benefits.” Most families with these plans receive a check from their insurance for a significant portion of our fee.
- HMO & EPO Plans: These plans are more restrictive and typically do not reimburse for out-of-network services unless a “Gap Exception” is granted.
3 – Use Your HSA or FSA
Since lactation consulting is a qualified medical expense, we proudly accept Health Savings Account (HSA) and Flexible Spending Account (FSA) cards. This is a great way to use your pre-tax dollars to cover your care with no out-of-pocket stress.
4 – How to Check Your Coverage (3 Simple Questions)
Before our visit, we recommend calling the “Member Services” number on the back of your insurance card. Ask them these three questions:
- “Does my plan cover outpatient lactation consultations (CPT codes 99404 and S9443)?”
- “Do I have out-of-network benefits for these services?”
- “If there are no in-network IBCLCs available for a home visit today, can I request a Gap Exception?”
5 – Self-Pay & Prompt Pay Discounts
If you do not have insurance coverage or have a high deductible, don’t worry. We offer a Prompt Pay Discount for families paying out-of-pocket at the time of service. We believe every mother deserves professional support, regardless of their insurance plan.