Self-Pay

If the lactating person is covered by BCBS of Massachusetts, Mass General Brigham, Harvard Pilgrim, or Tufts, I am an out-of-network provider and you should book a consult as a Self-Pay client and pay out of pocket. Typically, these major plans will reimburse you 100% for an unlimited number of consults, see Reimbursement Information, below, for details. If you are covered by Aetna, United, or Cigna, I am likely in-network with your plan, please follow the appropriate link for details.

If you are covered by ANY other insurance plan not listed above, you should also book as a Self-Pay client; reimbursement rates vary.

  • Typically, the 4 major Massachusetts insurance companies (BCBS of Massachusetts, Mass General Brigham, or Harvard Pilgrim, or Tufts) will reimburse families 100%. You pay out of pocket for the consult and then request reimbursement using a superbill. As a complimentary service for my clients with one of these 4 companies, I will file your reimbursement request to your insurance payer on your behalf.

    Lactation care is mandated to be covered under most insurance plans per the Affordable Care Act but the companies vary in terms of how they approach the mandate. I encourage you to call your insurance company and ask about their policy and process regarding reimbursement (not coverage) of lactation support for an out-of-network provider; this is especially recommended if you have a plan that’s not listed above. I cannot guarantee reimbursement.

    I also accept HSA/FSA cards; contact your HSA/FSA company directly to verify coverage.

  • BBA and HPI, while under the BCBS of MA or Harvard Pilgrim umbrellas, are third party administrators. These plans are not as reliable as “regular” BCBS of MA and HP in terms of reimbursement. Reimbursement rates vary by plan/company, and range from 0% to 100% and everything in between. I recommend calling the number on the back of your card to ask about your plan’s policy for reimbursement for lactation consultations.

    For these plans, I will provide you with a superbill to submit for reimbursement. I am not able to send this in for you on your behalf.

  • MassHealth plans are usually NOT eligible for reimbursement. Discounted services available for families participating in WIC or covered by Medicaid/MassHealth (please contact me directly to use this service).