Insurance Coverage for Lactation Services
No Cost to WIC Participants
The Lactation Foundation is affiliated with the Texas WIC Program.
- If you are enrolled in the Texas WIC program, you will receive all services at our clinic at no cost regardless of your insurance status.
- If you qualify for WIC but are not currently enrolled, we highly recommend that you enroll in order to ensure that you are eligible to receive lactation support services from our clinic at no cost.
- If you are enrolled in Medicaid, you are automatically eligible to receive WIC benefits, but you will need to enroll in the WIC program.
Insurance Coverage for Lactation Services
We are a preferred in-network provider for many insurance plans.
Common insurance companies with plans that cover lactation consultations at our clinic include:
- Ambetter from Superior HealthPlan
- Blue Cross Blue Shield Texas
- Community Health Choice
- Memorial Hermann Health Plan
- United Healthcare
- Most Medicaid plans (with PCP referral)
- … and others.
For additional plans that are accepted, visit https://www.utphysicians.com/insurance/ or contact your insurance company directly.
You may also check your insurance plan’s provider directory for Megan Oggero, APRN and/or Kelsie Barta, APRN to determine if you have in-network access to our clinic.
- Megan and Kelsie are dual-certified lactation consultants and family nurse practitioners. They are our billing providers and are the only providers at our clinic that will be listed in your insurance plan’s provider directory.
Verification of Benefits
Prior to your appointment at the Lactation Foundation, we will attempt to verify your benefits.
- This may not be possible for same-day appointments.
- We cannot guarantee coverage as your benefits may be subject to change.
- We recommend that you contact your insurance carrier regarding covered services related to lactation because:
- Your policy may require a referral or pre-authorization.
- You may have policy-related limits on your lactation benefits.
- Note: If your policy limits you to a certain number of visits, we may be able to ask for approval for additional visits if medically necessary.
- Some plans will only cover lactation services provided in person (not via telehealth).
The breastfeeding infant and the breastfeeding parent are two separate patients requiring independent assessment and documentation within their own separate medical records.
- We will submit claims to insurance for services rendered to each individually.
- Exceptions include prenatal appointments and appointments for parent-specific issues.
If your insurance company does not cover lactation services (some grandfathered plans), we can provide services according to our self-pay fee schedule. Please call our office for pricing.
The Affordable Care Act requires insurance companies to fully cover lactation services without limit and without cost sharing. However, your insurance company may apply a co-pay or co-insurance to your visit, put a portion of your visit cost toward your deductible, or limit the number of visits you may receive due to variations in their interpretations of the Affordable Care Act.
- In most cases, cost-sharing is not applied by the insurance carrier to the parent claim for lactation services.
- More frequently, insurance carriers apply cost-sharing to the infant claim.
Following your appointment, UTHealth will submit a claim to your insurance carrier, and you will receive explanation of benefits (EOB) documents from your insurance company for yourself and your infant. If your policy applies a co-pay or co-insurance or puts a portion of your visit cost toward your deductible, you will receive a bill from UTHealth for these charges. UTHealth is legally and contractually obligated to bill you due to our in-network relationship with your insurance company. If this happens, you may call your insurance company, reference the Affordable Care Act, and ask them to reconsider your claim. With varying success, this may eliminate or reduce your cost-sharing obligation. Ultimately, any balance owed to UTHealth is considered your responsibility.
If you have any questions, please contact our office at 713-500-2800.