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In-network with most BCBS plans

Lactation coverage for Blue Cross Blue Shield in Houston and San Antonio

Lactation billing has moving parts: referrals, visit limits, bundled codes, non-covered fees. That is why we verify your BCBS benefits before your first visit and put the full estimate in writing. Most patients hear back in one to two business days.

Billing team (281) 626-5271
A parent breastfeeding their baby while sitting on a sofa at home

A few BCBS plans we cannot bill

We are in-network with most BCBS plans, but some specific plan types do not cover IBCLC visits with us. If you are on one of these, you can still book as a self-pay patient and we will give you the rate up front.

  • BCBS Marketplace plans

    BCBS Marketplace (HealthCare.gov) plans are out of network for our IBCLCs.

  • BCBS Medicaid plans

    BCBS Medicaid plans are out of network for our IBCLCs.

  • Grandfathered BCBS plans

    We do not accept grandfathered BCBS plans (including BCBS Christus Health). These plans do not include lactation coverage, so self-pay rates apply. Verification will confirm whether your specific plan is grandfathered.

  • Out-of-state BCBS plans

    We are not in-network with these BCBS plans from other states. Visits are billed as cash-pay:

    • BCBS of Michigan
    • BCBS of Nebraska
    • BCBS Alabama
    • BCBS Anthem of Georgia (out of network)
    • Regence
    • Florida Blue
    • BCBS of Louisiana
    • BCBS of Kansas
    • Highmark
    • BCBS of Arkansas
    • BCBS of Arizona
    • BCBS of North Carolina
    • BCBS Horizon of Pennsylvania
How it works

How we work with your insurance

  1. You submit the intake form

    Tell us about your plan and what is going on with feeding. The form is HIPAA compliant and routes directly to our billing team.

  2. We verify your benefits

    Our billing team contacts BCBS to confirm in-network status, copay or coinsurance, deductible, visit limits, and any referral requirement.

  3. You get a written estimate

    Before your first visit you receive an email with your verified benefits and the expected out-of-pocket cost. No surprise bills after the fact.

  4. We file the claim

    After your visit we submit the claim to BCBS. If you owe a copay, coinsurance, or deductible, that is billed to the card on file.

BCBS rules to know

Plan-specific details for BCBS patients

Mom and baby billed separately

If mom and baby have different insurance plans, we submit a claim for each patient under the appropriate plan. Provide insurance information for both during intake.

HMO plans require a referral

All BCBS HMO plans require a referral before your first visit. You need a referral from your primary care provider and from the baby’s pediatrician. Without both, BCBS can deny the claim and the visit becomes self-pay.

Home-visit travel fee is patient-billed

Home visits incur a $70 travel fee billed directly to your card on file. The visit itself bills to BCBS under home visit codes the same way an office visit would.

Federal BCBS does not cover telehealth

Federal BCBS plans do not cover telehealth lactation visits. Most other BCBS plans do. For Federal BCBS patients who need a virtual visit, telehealth is available on a self-pay basis at our standard telehealth rate.

BCBS in-network plans

BCBS plans we accept

We are in-network with these BCBS plans and have billed them successfully. If your card shows one of these names, submit verification and we will confirm your coverage in writing.

  • BCBS Texas
  • BCBS Federal
  • BCBS UTS
  • BCBS Illinois
  • BCBS Oklahoma
  • BCBS New Mexico
  • BCBS Montana
  • BCBS of Tennessee
  • BCBS Massachusetts
  • BCBS Minnesota
  • BCBS Horizon of NJ
  • BCBS TRS
  • Independence BCBS
  • Premera
  • Blue California
  • Anthem California
  • Anthem Indiana
  • Anthem Nevada
  • Anthem Kentucky
  • Anthem Wisconsin
  • Anthem New Hampshire
  • Anthem Virginia
  • Anthem Colorado
  • Anthem Connecticut
  • Anthem Maine
  • Anthem New York
  • Anthem Missouri
  • Anthem Ohio
What is included

What BCBS coverage looks like with us

Typically covered

  • Initial postpartum lactation consultation (in office)
  • Follow-up lactation visits within plan limits
  • Nursing well checks within plan limits
  • Prenatal lactation consultation (most PPO plans)
  • Tongue-tie and oral function assessment
  • Pumping and back-to-work consultation

Patient-billed regardless of plan

  • Home visit travel fee ($70)
  • Telehealth visits on BCBS Federal plans (not covered; self-pay only)
  • Late-cancellation and no-show fees
  • Holiday-rate fees for after-hours visits
  • Visits beyond plan-allowed annual limits
  • Visits when a required referral was not obtained
  • Chiropractic care, bodywork, and laser therapy are cash-pay services, not billed under your medical plan

Confirming what your specific plan covers is the point of the verification step. The list above reflects general patterns across BCBS plans we work with, not a guarantee for any individual plan.

BCBS questions

BCBS-specific questions

How do I confirm my BCBS plan is in-network?

Log in to your BCBS account, go to Find a Doctor, and search for “lactation consultants.” You may need to expand the search radius to fifty miles to see us in the results. The most reliable check is our verification step: submit the intake form and our billing team will confirm your plan directly with BCBS, including any restrictions or referral requirements.

My BCBS plan is HMO. What does the referral process look like?

For HMO plans you need two referrals before the first visit: one from your primary care provider and one from the baby’s pediatrician, both naming us as the lactation provider. Verification will confirm whether your specific HMO requires this. If a claim is denied for a missing referral that was not obtained before the visit, the visit becomes self-pay.

My plan was not listed in the plans you cannot bill. Am I covered?

Most likely yes, but verification is the only way to be certain. The list above covers the BCBS plans we have confirmed we cannot bill. Individual employer-sponsored BCBS plans sometimes have unusual restrictions that only show up at the policy level. Submit verification and you will get the answer in writing within one to two business days.

What is a grandfathered plan and how do I tell if my plan is grandfathered?

A grandfathered plan is a health plan that was created before March 23, 2010 and has not made significant changes to its benefits, costs, or coverage since then. Both employer-sponsored and individual plans can be grandfathered. The only way to know for certain is to call BCBS or review your plan documents, which will state whether your plan is grandfathered.

Do I need to wait for my insurance to be verified before booking my appointment?

No. You can book your appointment before your insurance is verified. As long as you submit your insurance information at least 1–2 business days (Monday through Friday) before your appointment, our team will have enough time to verify your coverage prior to your visit. If you are submitting the day before your scheduled visit, please submit by 3 PM so we have time to verify.

If we discover that your plan is not covered or has unusual restrictions, we will notify you by email and text message. If you decide to cancel your appointment due to lack of coverage, we will waive the cancellation fee as long as you request cancellation on the same day we notify you.

Other carriers

Have a different carrier?

We are in-network with these as well.

Ready to Get Started?

Request your appointment, and we’ll verify your insurance benefits before your visit.

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