In-network means lactation services can be processed through insurance, subject to plan-specific cost-sharing, deductibles, or coinsurance.

Plans that are typically In-Network:

✅ PPO plans

✅ Point of Service (POS) plans

✅ Open Access Plus (OAP) plans

⚠️ Select plans (benefits must be verified)

⚠️ Aetna subsidiary plans (benefits must be verified)

Plans that are out of network:

❌ HMO plansCare is typically covered as a preventive benefit. Most Aetna plans cover approximately 3–6 visits per rolling calendar year, though coverage and cost-sharing vary by plan.

While many families have little to no out-of-pocket cost for visits, some plans do apply copays, coinsurance, or deductible amounts, particularly after covered visits are exhausted or for infant appointments.

If the family deductible has been met by the birth, cost-sharing is often limited to the specialist copay.

If the deductible has not been met, the baby’s appointment is typically applied toward the deductible and may fall in the $60–100 range, depending on the plan. Any applicable cost-sharing is invoiced after claims are processed.

If you have taken prenatal or breastfeeding classes through programs such as Aeroflow or Baby Academy, some plans may count those services toward available lactation benefits, which could reduce the number of fully covered visits.

If you’re unsure about your coverage, please complete a benefits check below.

In-network means lactation services can be processed through insurance, subject to plan-specific cost-sharing, deductibles, or coinsurance.

Plans that are typically In-Network:

✅ Most PPO plans are in-network

✅ Most EPO plans are also in-network

✅ Anthem PPO (not including PPO Prudent Buyer), Regence PPO, Premera PPO, and Federal Employee Plans (Basic, Standard, PPO) are almost always covered for lactation

Plans that are always out of network:

❌ Regence Legacy

❌ Blue Shield of California metal-tier plans (Bronze, Silver, Gold, Platinum)

❌ Most HMO plans are not in-network, with limited state-specific exceptions (currently Oregon only).

Visits are covered as medically necessary, and many plans allow for unlimited, ongoing visits without a preset number defined, subject to your plan’s specific benefits. This typically includes home, office, telehealth, and hospital visits.

Some plans include cost-sharing for the lactating parent, the baby, or both.

Cost-sharing simply means the portion your insurance plan assigns to you, such as a copay, coinsurance, or deductible (average cost-sharing amount is $10-20 per appointment). This varies by plan and isn’t always required.

If you’re unsure about your coverage, please complete a benefits check below.

In-network means lactation services can be processed through insurance, subject to plan-specific cost-sharing, deductibles, or coinsurance.

Plans that are typically In-Network:

✅ PPO plans

✅ POS plans

✅ Open Access Plus (OAP) plans

✅ EPO plans

⚠️ HMO plans (require a referral from your OB/GYN, midwife, PCP, or pediatrician)

Additional plan notes:

Allegiance Cigna: Telehealth visits are not permitted. Baby appointments typically include cost-sharing (approximately $150). Visits for the lactating parent are generally covered without cost-sharing.

Visits are covered as medically necessary, and many plans allow for unlimited, ongoing visits without a preset number defined, subject to your plan’s specific benefits. This typically includes home, office, telehealth (when permitted), and hospital visits.

Some plans include cost-sharing for the lactating parent, the baby, or both.

Cost-sharing simply means the portion your insurance plan assigns to you, such as a copay, coinsurance, or deductible (average cost-sharing amount is $10-20 per appointment). This varies by plan and isn’t always required.

If you’re unsure about your coverage, please complete a benefits check below.

Includes UnitedHealthcare, UMR, GEHA, Empire, and Oxford plans.

In-network means lactation services can be processed through insurance, subject to plan-specific cost-sharing, deductibles, or coinsurance.

Plans that are typically In-Network:

✅ PPO plans

✅ EPO plans

✅ Choice Plus plans

✅ Individual Exchange plans (Arizona only)

✅ Doctor’s Plan, Navigator, Core, and Nexus plans (must be verified)

⚠️ HMO plans (must be verified; many are not in-network)

Plans that are always out of network:

❌ SignatureValue HMO

❌ Oxford Metro

❌ Heritage

❌ Neighborhood Health Plan

❌ Community Health Plan

Visits are covered as medically necessary, and many plans allow for unlimited, ongoing visits without a preset number defined, subject to your plan’s specific benefits. This typically includes home, office, telehealth, and hospital visits.

Some plans include cost-sharing for the lactating parent, the baby, or both.

Cost-sharing simply means the portion your insurance plan assigns to you, such as a copay, coinsurance, or deductible (average cost-sharing amount is $10-20 per appointment). This varies by plan and isn’t always required.

If you’re unsure about your coverage, please complete a benefits check below.

In-network means lactation services can be processed through insurance, subject to plan-specific cost-sharing, deductibles, or coinsurance.

Plans that are typically In-Network:

✅ TRICARE Prime

✅ TRICARE Select (including Reserve, Retiree, Young Adult, and related plans)

Important plan notes:

You must be at least 27 weeks pregnant for a prenatal lactation consultation.

Plans that are out of network:

❌ TRICARE Overseas

Some plans include cost-sharing for the lactating parent, the baby, or both. Cost-sharing simply means the portion your insurance plan assigns to you, such as a copay, coinsurance, or deductible (average cost-sharing amount is $10-20 per appointment). This varies by plan and isn’t always required.

If you’re unsure about your coverage, please complete a benefits check below.

If you don’t see your plan listed, please reach out so we can check your coverage.