Lactation coverage for Humana in Houston and San Antonio

We are in-network providers with Humana, billing direct under our own contract. Most Humana commercial plans cover lactation visits with us under the Affordable Care Act’s preventive-services rules. We verify your benefits in advance and put the full estimate in writing.

Billing team (281) 626-5271

A parent nursing their baby while sitting on the living-room floor at home

Humana plan types we cannot bill

Most Humana plans we accept. These specific plan types may 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.

Humana Medicaid plans

Humana Medicaid products are out of network for our IBCLCs.
Humana Medicare Advantage plans

Lactation services are not a typical Medicare Advantage benefit. If you are on a Humana Medicare Advantage plan and need lactation support (for example as a grandparent caregiver), the visit is self-pay.
Grandfathered (pre-ACA) plans

Some Humana-administered plans predate the Affordable Care Act and are exempt from preventive-service requirements. Lactation visits may not be covered on these plans.

How it works

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 contacts Humana to confirm 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 Humana. If you owe a copay, coinsurance, or deductible, that is billed to the card on file.

Humana rules to know

Plan-specific details for Humana patients

We do not bill Humana HMO plans

We are not in-network with Humana HMO plans and cannot bill them. If you have a Humana HMO plan, you can still book as a self-pay patient and we will give you the rate up front. Humana PPO and other non-HMO plans are billed as described here.

Confirming in-network status

You can check in-network status by logging in to your Humana member portal and searching for “Lactation Consultants.” Expand the search radius to fifty miles if needed. The most reliable check is our verification step, which confirms the answer in writing.

Mom and baby billing

Most lactation visits involve assessment of both parent and baby. We submit separate claims for each. Provide insurance information for both during intake. If both have Humana coverage, both claims process under Humana.

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 Humana under home visit codes the same way an office visit would.

What is included

What Humana coverage looks like with us

Typically covered

Initial postpartum lactation consultation (in office)
Follow-up lactation visits within plan limits
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 on grandfathered plans not covering lactation
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 we expect across Humana plans, not a guarantee for any individual plan.

Humana questions

Humana-specific questions

My Humana plan is an HMO. Can you bill it?

We are not in-network with Humana HMO plans and cannot bill them. You are welcome to book as a self-pay patient, and we will give you the rate up front. Humana PPO and other non-HMO plans are billed through your insurance as usual.

Will I have any out-of-pocket costs?

For most ACA-compliant Humana plans, the lactation portion of the visit processes as preventive care for the lactating parent and has no out-of-pocket cost. The baby’s portion of the claim can have copay, coinsurance, or deductible applied depending on your plan. Verification provides your estimated out-of-pocket costs.

My Humana card mentions ChoiceCare. Are you in-network?

ChoiceCare is Humana’s commercial PPO provider network. We are in-network for Humana plans that use ChoiceCare. Verification confirms your specific plan and network.

Are all of your providers in-network with Humana?

Not all of our providers are in-network with Humana. When you reach out, we will let you know which of our providers you can see under your Humana plan.

I have Humana Medicare Advantage. Can you still see me?

Humana Medicare Advantage plans typically do not cover lactation services as part of the Medicare benefit structure. We can see you as a self-pay patient and will provide the rate up front. If you are caring for a grandchild and need lactation support, this is the most common path.

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