Lactation coverage for MultiPlan (now Claritev) and PHCS plans in Houston and San Antonio
MultiPlan (now Claritev), PHCS, and Imagine 360 are provider networks, not insurance companies. Many self-funded employer plans rent access to one of these networks, so your insurance card shows the network logo next to the name of the company that actually administers your benefits. We are in-network through these networks and bill your plan the same way we bill a major carrier. Because self-funded plans set their own rules, we verify your specific benefits in advance and put the full estimate in writing. MultiPlan recently rebranded as Claritev, so you may see either name on your paperwork; we recognize both.
When a MultiPlan or PHCS logo means we are in-network
A network logo on your card tells us how your plan finds providers, not what it covers. Most plans that use these networks cover lactation visits with us. A few do not. If yours is one of the exceptions below, you can still book as a self-pay patient and we will give you the rate up front.
-
Plans that carve out lactation
A self-funded employer can rent the network but exclude lactation, or apply standard cost-sharing instead of preventive coverage. Verification confirms whether yours does.
-
Medicaid and Medicare products
Medicaid and Medicare Advantage plans that route through these networks are out of network for our IBCLCs.
-
Grandfathered plans
Pre-ACA grandfathered plans do not include lactation coverage. Self-pay rates apply. Verification will confirm whether your specific plan is grandfathered.
How we work with your insurance
-
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.
-
We verify your benefits
Our billing team identifies who actually administers your plan behind the network logo, then confirms in-network status, copay or coinsurance, deductible, visit limits, and any referral requirement.
-
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.
-
We file the claim
After your visit we submit the claim to your plan’s administrator. If you owe a copay, coinsurance, or deductible, that is billed to the card on file.
Plan-specific details for MultiPlan and PHCS patients
Your card shows the network, not the administrator
MultiPlan, PHCS, and Imagine 360 are the network your plan rents. The company that pays the claim is usually a separate administrator printed elsewhere on your card. We verify with that administrator, which is why we ask for a clear photo of both sides of your card at intake.
Self-funded plans set their own rules
Most plans on these networks are self-funded by an employer, so visit limits, cost-sharing, and preventive coverage vary from one employer to the next. There is no single “MultiPlan benefit.” Verification confirms what your specific plan allows before your visit.
Mom and baby billing
Some plans on these networks, including certain Imagine 360 plans, pay a single claim per visit, mom or baby, not both. Where that applies, a non-covered infant fee may apply. Verification confirms whether your plan operates this way and the exact amount before you book.
Prior lactation services count toward your benefit
Many plans cover a set number of lactation visits per year across all providers, not visits with us specifically. Visits from a pump-company prenatal class, a hospital outpatient clinic, or a physician’s office can count against that benefit. Tell us about any prior lactation visits at intake so the estimate is realistic.
Logos that point to a rented network
If your insurance card shows one of these names, your plan most likely uses a rented provider network. Submit verification and we will confirm how your plan routes and whether we are in-network for it.
-
MultiPlan
-
Claritev (formerly MultiPlan)
-
PHCS (Private Healthcare Systems)
-
Imagine 360
-
HealthSmart
-
First Health
What coverage looks like with us
Typically covered
- Initial postpartum lactation consultation (in office)
- Follow-up lactation visits within plan limits
- Prenatal lactation consultation
- Tongue-tie and oral function assessment
- Pumping and back-to-work consultation
- Home visits
Patient-billed regardless of plan
- Home visit travel fee ($70)
- Late-cancellation and no-show fees
- Visits beyond plan-allowed 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 the plans we work with, not a guarantee for any individual plan.
MultiPlan and PHCS questions
My card says MultiPlan (or PHCS). Is that my insurance company?
No. MultiPlan and PHCS are provider networks. Your plan rents the network to find in-network providers, but a separate administrator actually pays the claims, and that company is usually named elsewhere on your card. When you submit verification, send a photo of both sides so we can identify who administers your plan and confirm your benefits.
Are you in-network for my MultiPlan or PHCS plan?
In most cases, yes. We are credentialed through these networks the same way we are with the major carriers. Because each employer plan sets its own coverage rules, the only way to be certain about your plan is verification, which we complete before your first visit and put in writing.
My plan is administered by Imagine 360 or PHCS. Will both my baby and I be billed?
Some plans on these networks pay a single claim per visit, mom or baby, not both. Where that applies, we bill the lactating parent under the lactation benefit and apply a non-covered infant fee for the baby’s portion. Verification will confirm whether your specific plan operates this way and the exact amount before you book.
What if verification shows my plan is not covered?
If your plan does not cover lactation visits with us, we will tell you in writing and quote the self-pay rate up front. If your plan includes out-of-network benefits, we can provide an itemized superbill so you can submit for reimbursement on your own.
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.
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.
Request Appointment Opens our secure intake form in a new tab.