We are in-network with most commercial Aetna, Anthem BCBS, United Healthcare and CIGNA plans. Upon submitting the intake form, we will verify your benefits and notify you if we cannot accept your insurance or if there may be any out of pocket. Scroll down for payer-specific information, including how to call and check your benefits.

Payment is required up front. Up-to-date fee information for each service is available in the online booking widget.

If you would like to call your insurance to request an out-of-network exception, you can give them this information:

• NPI: 1144722174
• EIN: 824615241
• Code S9443, billed amount $475

We will provide you with a superbill with code S9443 under the lactating parent that includes the insurance information you provide to us. We cannot guarantee that your insurance will reimburse you under the Affordable Care Act.

If you would like a home visit, you will pay a convenience fee of $75 for each visit. The home visit convenience fee is non-refundable if you cancel with less than 24 hours’ notice. This fee is not eligible for insurance reimbursement. The self-pay fee includes the home visit fee.

Sliding scale may be available if you or your partner(s) meet one of these qualifications: on WIC, on Medicaid, DOE teacher, or unemployed.

Please contact us prior to booking to request sliding scale for the self-pay rate or waiver of the home visit convenience fee.

We cannot waive cost-sharing for our in-network clients even on a sliding scale basis (unfortunately this is considered insurance fraud and we don’t do that).

We cannot guarantee that your covered services will not have cost-sharing applied by your insurance. Even if your insurance told you that you have full coverage for lactation care, there will likely be limitations and restrictions on care that may differ from plan to plan. We cannot legally or contractually waive the cost-sharing under any circumstance. We are required by law to invoice you.

Messaging support is available for $75/week. We offer a free week of messaging support to our self-pay clients after each date of service. Insurance clients are eligible for a week of messaging support if $75 or more goes towards your deductible for a single date of service.

We submit a claim for you and for your baby (when present). That is two separate claims for two separate people. You and your baby do NOT need to be on the same insurance for services to be rendered.

If one of you is out-of-network, we will still submit an out-of-network claim to the insurance in the hopes that they will pay something.

Once both of your claims have been processed, we will balance bill you for any amount not covered by either insurance up to our listed self pay fee for the type of visit you had. We will never charge you any amount that would cause us to collect more than our stated self pay fee from you and your insurance combined.

Example 1: The self pay fee for the service is listed as $200. We bill each insurance $200. Your in-network insurance pays $100. Your baby’s out-of-network insurance pays $10. You would be balanced billed $90.

Example 2: The self pay fee for the service is listed as $200. We bill each insurance $200. Your baby’s in-network insurance pays $100. Your out-of-network insurance pays $200. You would not be billed anything.

We are in-network with Aetna and its subsidiaries. We are not in-network with 1199. If you would like a home visit, you will pay a convenience fee of $75 for each visit. The home visit convenience fee is non-refundable if you cancel with less than 24 hours’ notice. This fee is not eligible for insurance reimbursement.

You can call Member Services and ask if we are in-network using this information: Annie Frisbie IBCLC Inc, NPI 1144722174 and EIN 824615241. All City Lactation providers are in-network under this NPI.

Aetna may have told you that you would get up to 6 “free lactation visits.” But in reality you can have as many sessions with us as you need, and that in most cases you may only have to pay a small amount if your baby has a deductible or specialist copay. On request, we can provide you with our best estimate of what cost-sharing or out-of-pocket for you or your baby might be. The home visit fee may not be applied to cost-sharing. ​

So what does Aetna actually mean when they say you get 6 visits? This is going to get a little technical, so bear with me. There is a code called S9443 which covers a lactation session by a non-physician provider. Aetna gives you 6 uses of this code that can be used for you and/or your baby.  In order to provide comprehensive lactation care for you and your baby, we bill S9443 for you and for your baby. The reason we bill S9443 for both you and your baby is because it will not count to anyone’s deductible. It allows us to receive payment and minimize or even eliminate potential out-of-pocket costs to you. 

Each in-person visit with us will use up 2 of what Aetna calls your “free lactation visits.” A prenatal session or a virtual session uses up 1. If you saw another lactation consultant before seeing us, or if you took a class from the company that sent you your breast pump, you may have already used up some of your S9443 benefit. 

For in person visits, City Lactation will not bill you for S9443 after it has been used up. For virtual visits, Aetna only allows us to use S9443 and one other code that may go to your deductible if you have one. You will be billed for any deductible for you or your baby, and for S9443 if it has been maxed out or if your plan does not cover lactation. We will tell you in advance of the visit exactly how much that amount will be.

We are in network with most commercial plans: BLUE ACCESS, EPO, HMO, INDEMNITY& PPO. We do not accept Medicaid. If you would like a home visit, you will pay a convenience fee of $75 for each visit. The home visit convenience fee is non-refundable if you cancel with less than 24 hours’ notice. This fee is not eligible for insurance reimbursement.

You can call Member Services and ask if we are in-network using this information: Annie Frisbie, NPI 1467796268 and EIN 824615241. If Annie is showing up as in-network, then Kara, Patricia, and Suzi will be as well. You can also text your insurance info to 917-830-3153 and we can look it up on our end.

Each and every Anthem plan has different preventive care guidelines. Some of these are published and freely available to us. Others are not available to us at all. We will also let you know if we have any concerns about your coverage. Typically if we are in-network, you can see us as many times as you like. A copay, coinsurance, or deductible may apply, but unfortunately Anthem BCBS doesn’t give us a way to find that out in advance. We recommend you call your plan and ask if your plan covers preventive care and lactation, specifically codes S9443 and 99404. ​

We are in-network with CIGNA and can bill them directly. There is typically no out-of-pocket for you or limitations on the number of times you can see us.

You can call Member Services and ask if we are in-network using this information: Annie Frisbie IBCLC Inc, NPI 1144722174 and EIN 824615241. All City Lactation providers are in-network under this NPI.

If you would like a home visit, you will pay a convenience fee of $75 for each visit. The home visit convenience fee is non-refundable if you cancel with less than 24 hours’ notice. This fee is not eligible for insurance reimbursement.

We are in-network with commercial plans through UnitedHealthcare Insurance Company and its affiliates. We are out-of-network for Oxford Liberty, Oxford Metro, Medicaid, and Essentials plans.

You can call Member Services and ask if we are in-network using this information: Annie Frisbie IBCLC Inc, NPI 1144722174 and EIN 824615241. All City Lactation providers are in-network under this NPI.

There are typically no limitations on the number of times you can see us and there is typically no out-of-pocket for you or your baby.

If you would like a home visit, you will pay a convenience fee of $75 for each visit. The home visit convenience fee is non-refundable if you cancel with less than 24 hours’ notice. This fee is not eligible for insurance reimbursement.