Lactation care encompasses the dyad—both you and baby. Because your clinician will carefully assess and careplan to meet your goals and your baby/ies needs, there will be two claims: one for you and one for baby. Appointments will consist of a health history of the dyad; a breast and nipple assessment for parent and oral anatomy assessment for baby; pre- and post-feed weight to evaluate transfer of milk; guidance on calibrating supply; assessment of latch/positioning; assistance with all feeding aids/equipment; and a care plan to help you meet your breastfeeding goals and support your baby’s needs.

Yes, we currently are able to accept Aetna, BCBS/Carefirst, DC Medicaid and United/GEHA insurance plans for visits with our lactation consultants. However, we always suggest giving your insurance company a call to see how lactation care is covered under your particular plan.

Some plans may require some amount of “patient responsibility,” e.g. a copay, coinsurance, or may apply a deductible. We will bill your insurance company, and follow up with you by email with an invoice if your insurance determines any amount of “patient responsibility.” In our experience, it is only some plans (25-50% of our clients) that experience a copay/coinsurance/deductible, and the amount typically ranges between $15-75 per appt. Your usual specialist deductible would be a good gauge of the amount you could potentially expect to pay--if anything at all.

Please understand that the Travel Fee of $125 (for home visits only) and all breastfeeding or pumping supplies used must be paid for by you, out of pocket, and cannot be billed to your insurance. But you CAN typically use your FSA/HSA funds for these items or fees. As always, we suggest you call your FSA/HSA manager to confirm your coverage and any necessary receipts or paperwork.

The card that you place on file at the time of your visit will be the card to which any invoices are applied. Invoices are sent to the email address provided when you submit your intake form. Invoices are automatically charged after 7 days of sending by email. If you’d prefer to use a different card, set up a payment plan, or delay payment, please just give our office a call at 202.293.5182–we are more than happy to work with you on payment.

Our out-of-network clients pay up front at the cash rate of (see below) at the time of service. We will then provide you with the forms to submit to your insurer for reimbursement via email.

If 100% coverage, or full reimbursement is important to you, then we STRONGLY suggest you call them. Just call the phone number on the back of your insurance card and have your insurance ID number ready. Some plans may require a pre-certification or gap exception, or they may require pre-authorization for continued appointments. Please review the NWLC Toolkit on lactation care, and DOL FAQs to understand what the law requires your insurance company to cover.

We suggest that you ASK your insurance company for a list of in-network providers for lactation consultation, if cost is a concern and they are able to provide you with an in-network option you should consider that first. However, most will not be able to provide you with a list of any in-network options for lactation care. Again, if they do not have in-network providers, the law requires them to cover out-of-network providers fully. If you have Aetna, BCBS/Carefirst, DC Medicaid, or United/GEHA and they indicate that we are not in-network, please call us or ask to confirm this information with a supervisor. The Center is in-network for most, if not all, plans within these networks.

We always suggest calling your insurance company to confirm your coverage, but truthfully individual reps can sometimes be under-informed about what the law requires. So please confirm any information you get from your insurance company with us, especially if it limits your care. The ACA requires that breastfeeding classes and consults be covered “for the duration of breastfeeding.” “Reasonable medical management” of care is allowed, but in our experience is rarely used. One practice of “reasonable medical management” is where an insurance provider dispenses 6 classes or appointments at a time, but because lactation care is required to be covered for the duration of breastfeeding, you can almost always call back and request another 6 visits if you need further care. In practice, we haven’t ever seen anyone actually be limited to a certain number of classes or appts, so please don’t self-limit your care if you feel you need to be seen. If you’re truly concerned about insurance coverage, please email us at insurance@breastfeedingcenter.org to discuss. Our priority is always getting you the care you need, regardless of insurance coverage or ability to pay. Please also see our financial assistance options, and let us know if you’d like to take advantage of one of these programs.

A pre-certification is the process of getting approval from your health plan before you have any health procedures performed. Getting pre-certification for certain procedures helps you and your provider know what is covered by your health plan before any services are performed. For lactation consultations, it also may mean a higher rate of reimbursement from your insurance company. 

To get a pre-certification, you will just need to call your insurance company, tell them you have an appointment scheduled with us, and check to see what information they need. If we are not in-network with your insurance company, we will not be able to call them on your behalf to get this pre-cert, it will be something you have to call to have put in place on your account.

Some of our clients have found this information helpful:

Our Address: 1020 19th St NW, Suite 150, Washington, DC 20036

Our Tax ID: 83-0575270

Our Billing NPI: 1427534783

A gap exception is something you can request from your insurance company when your insurance company does not have any provider within a certain amount of miles (typically 30), or if they do not have enough providers with available appointments within that area, for a service that they are required to cover. Insurance companies are required to cover lactations consults under the ACA. A gap exception can help facilitate your full reimbursement when going to an out-of-network provider.

To get a gap exception, you will just need to call your insurance company, tell them you have an appointment scheduled with us, and check to see what information they need. If we are not in-network with your insurance company, we will not be able to call them on your behalf to get this gap exception, it will be something you have to call to have put in place on your account.

Some of our clients have found this information helpful: :

Our Address:1020 19th St NW, Suite 150, Washington, DC 20036

Our Tax ID: 83-0575270

Our Billing NPI: 1427534783

Some plans may also require the gap exception to be called in by an in-network, referring provider, such as your OBGYN, midwife or PCP.

You can schedule online here. If you have any questions, please call us, or TEXT us at 202-293-5182.

We cannot guarantee reimbursement from any insurance company. Please always call your insurance company for the most up-to-date information.

As a nonprofit, The Breastfeeding Center takes pride in providing low cost and free programming to expectant, new, and experienced families without insurance or those experiencing financial hardship. We never want payment to be an issue that stops you from receiving the care that you need.  See our Financial Assistance resources available to our community with the intent to support all families during their breastfeeding journey.