Insurance, Fees & Policies
Which insurance plans are you in-network with?
We are in-network with Aetna, UHC, UMR, GEHA, MGBHP, Tricare, BCBS PPO (some HMOs too). 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.
What are the costs if you don’t take my insurance?
Up-to-date fee information 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: 1497400188 & 1932854627
- EIN: 87-4699023
- Code S9443, billed amount $350
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.
What is the home visit travel fee?
Equally Expressed, LLC offers in-home lactation visits within a 60-mile round-trip radius from North Andover, MA (01845). To support continued access to personalized care, a travel fee is added to all home visits based on round-trip mileage.
Travel fees are determined using Google Maps and are calculated from zip code 01845 to your home.
Roundtrip Miles | Fee | Roundtrip Miles | Fee |
---|---|---|---|
0–10 | $25 | 31–35 | $75 |
11–15 | $35 | 36–40 | $85 |
16–20 | $45 | 41–45 | $95 |
21–25 | $55 | 46–50 | $105 |
26–30 | $65 | 51–55 | $115 |
56–60 | $125 |
Important Information
- The travel fee is non-refundable if you cancel your home visit with less than 24 hours’ notice.
- This fee is not eligible for insurance reimbursement or use with FSA/HSA accounts.
- If you’re located beyond 60 miles, please reach out—we may be able to accommodate on a case-by-case basis with adjusted rates.
- In-office appointments are available for families who prefer to avoid a travel fee or are outside the home visit service radius.
- We reserve the right to reschedule home visits due to severe weather, road closures, or safety concerns.
Is a sliding scale available?
Sliding scale may be available if your family meets one of these qualifications: Federal Poverty Level below 250%, WIC, SNAP, Medicaid
Please contact us prior to booking to request sliding scale for the self-pay rate.
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).
Can you guarantee my covered services will have no cost-sharing?
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.
How does follow up work?
At Equally Expressed, LLC, we are committed to providing continuous, personalized support throughout your lactation journey. To ensure optimal care:
Flexible Booking: You are always welcome to book additional appointments directly through our website or by contacting us, should new concerns arise or if you seek further support.
Scheduling Next Appointments: We typically schedule your next appointment before concluding the current session to maintain continuity of care.
We advocate for proactive and timely consultations to address common breastfeeding and lactation milestones:
Prenatal Period
- Initial Consultation: Around 26–32 weeks gestation for a private or group prenatal class.
- Follow-Up Sessions: 1–2 additional visits to reinforce techniques, address concerns, review hand expression, and ensure readiness for breastfeeding postpartum.
Immediate Postpartum
- Early Postpartum Visit: Within 3–5 days after birth to evaluate latch, milk transfer, and address any immediate concerns.
Ongoing Support
- Flange Fitting & Pumping Guidance: As needed, especially when introducing pumping or experiencing discomfort.
- Return to Work Planning: Approximately 3-4 weeks before resuming work to develop a pumping schedule, discuss milk storage, and navigate workplace accommodations.
- Introducing Solids: Around 6 months of age to discuss readiness cues, appropriate foods, and maintaining milk supply.
- Weaning Support: When considering reducing or stopping breastfeeding, to ensure a comfortable transition for both parent and child.
- Additional Concerns: Including teething, nursing strikes, or any feeding difficulties that may arise
How are claims submitted?
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.
What if one of us is out-of-network?
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 $350. We bill each insurance $350. Your in-network insurance pays $200. Your baby’s out-of-network insurance pays $10. You would be balanced billed $140.
Example 2: The self pay fee for the service is listed as $250. We bill each insurance $250. Your baby’s in-network insurance pays $200. Your out-of-network insurance pays $100. You would not be billed anything.
Aetna
We are in-network with Aetna and most of its subsidiaries.
You can call Member Services and ask if we are in-network using this information: NPI 1932854627 and EIN 87-4699023.
Aetna may have told you that you would get up to 6 “free” lactation sessions. They probably did not also explain to you that they place strict limitations on what those free sessions actually include.
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. Services that we offer which are fully covered by this code include:
- Virtual prenatal
- Virtual check in for existing clients
- In office prenatal
- In office flange fitting
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.
But since you only get 6 uses of S9443, that code does run out. After six uses of this code, Aetna will tell you that S9443 is now “patient responsibility.” You will be responsible for any amount applied to your deductible, and balance billed up to our published self pay rate for the type of appointment you had on that date of service (initial, follow up, or prenatal).
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. We cannot see how many you have left.
In addition, we bill time-based codes that cover the additional time required to provide comprehensive care. If you have not met your deductible, the time-based code we bill for your baby will go to your deductible. If you have a specialist copay, it may apply to your baby’s claim. You will be invoiced for cost-sharing and your card on file will be billed.
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.
Anthem BCBS
[If you take Anthem, you can use this wording.]
You can call Member Services and ask if we are in-network using this information: NPI XXX and EIN XXX.
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. The Anthem system only tells us if you have active coverage. They do not tell us if there are any limitations in place on your plan. We recommend you call your plan and ask if your plan covers preventive care and lactation, specifically codes S9443 and 99404.
CIGNA
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: NPI XXX and EIN XXX.
United Healthcare
We are in-network with commercial plans. 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.
You can call Member Services and ask if we are in-network using this information: NPI 1497400188 and EIN 87-4699023.