Rooted Maternal Wellness will submit claims directly to your insurance provider for services rendered to you and your baby or babies. Under the Affordable Care Act, lactation services are classified as preventive and should not be subject to cost-sharing. Rooted Maternal Wellness will make every effort to appeal any cost-sharing charges (such as deductibles or coinsurance). However, if the appeal is unsuccessful, your credit card on file will be charged for any outstanding amounts. If payment fails, you agree to pay the invoiced amount within seven (7) days.

You are responsible for informing us of any changes to your insurance coverage for both you and your baby.

Insurance and Payment Policies 

rooted maternal wellness

Accepted Insurance

The Lactation Network (TLN)


If you have BCBS PPO, Anthem PPO, United PPO, VA CCN, or any subsidiary of these plans—or if your insurance card has a Multiplan or PNOA logo on the back—you may qualify for up-front insurance coverage through TLN.

Pre-Approval Required: Use the following link to request pre-approval: Check TLN Coverage​
Important: Pre-approval must be completed before your appointment. Without it, you may be responsible for paying out-of-pocket for your visit.

Cigna


If you are insured through Cigna, you may qualify for up-front coverage through Wildflower, a contracted billing company.

Pre-Approval Required: Use the following link to request pre-approval: Check Wildflower Coverage​
Important: Pre-approval must be completed prior to your appointment. Without it, you may be responsible for paying out-of-pocket for your visit.

Aetna


Rooted Maternal Wellness is in-network with Aetna, and you may qualify for insurance coverage for lactation consultations.

Coverage Changes: Starting March 2024, Aetna no longer covers six full consultations for the lactating parent. Instead, they cover six codes. Each consultation requires two codes—one for the parent and one for the baby—effectively covering three consultations.
Primary Insurance Requirement: To file claims, both you and your baby must have Aetna as your primary insurance.
Out-of-Network Baby Coverage: If your baby is covered by an out-of-network plan, we will bill Aetna for your portion but will require a $125 payment per visit for the baby’s portion.
Denial of Coverage: If Aetna denies coverage entirely, you will be responsible for the full self-pay fee. A superbill will be provided for potential reimbursement.
Exceeding Coverage: If you use all six covered codes and need further support, contact us to explore additional options.

Insurance Coverage Verification

NPI numbers for verification:


Rooted Maternal Wellness: 1003651449
Nicole Farese, IBCLC: 1336984673

When verifying coverage, ask for a call reference number and document the date of the call.

Special Instructions for Certain Plans:


If you have BCBS PPO, Anthem PPO, United PPO, or VA CCN, you will verify coverage through The Lactation Network (TLN).
Check Coverage Here: The Lactation Network​

​If you have Cigna, you will verify coverage through Wildflower.
Check Coverage Here: Wildflower​

It is your responsibility to check with your insurance provider to confirm coverage for lactation services.

Out-of-Network Insurance

Self Pay


Self-Pay Rates: $300 for the initial visit, $200 for follow-ups. A superbill will be provided for you to submit for potential reimbursement.

Split Billing: Insurance & Self-Pay


If you are on a in-network insurance but your baby is on an out-of-network plan, the self pay rate for the non-insured half: $125. A superbill will be provided for you to submit for potential reimbursement.

For out-of-network primary insurance, full payment of the self-pay fee is required upfront. Refunds are only issued if Rooted Maternal Wellness receives direct payment from your insurance, and only for the exact amount received.

General Policies

Client Classification: You and your baby are considered a collective client. The initial visit includes one week of follow-up support through secure messaging, email, or text. Continued support is available for an optional weekly fee, which is not eligible for insurance reimbursement.
Travel Fees: If applicable, travel fees are not eligible for insurance reimbursement.
Verification Responsibility: Rooted Maternal Wellness can confirm basic insurance coverage but cannot account for special circumstances or exclusions. If claims are denied, you are responsible for the self-pay rate.


Rooted Maternal Wellness may communicate with your insurance provider regarding services provided and with your credit card company or bank for payment-related matters. You are responsible for providing accurate and current payment and insurance information and for updating your credit card details as needed. Any costs or fees resulting from failure to provide updated information are your responsibility.

These policies apply to Rooted Maternal Wellness and its representatives.


Insurance Coverage Verification
It is your responsibility to check with your insurance provider to confirm coverage for lactation services.

NPI numbers for verification:
Rooted Maternal Wellness: 1003651449
Nicole Farese, IBCLC: 1336984673
When verifying coverage, ask for a call reference number and document the date of the call.

Special Instructions for Certain Plans:
If you have BCBS PPO, Anthem PPO, United PPO, or VA CCN, you will verify coverage through The Lactation Network (TLN).
Check Coverage Here: The Lactation Network​

​If you have Cigna, you will verify coverage through Wildflower.
​Check Coverage Here: Wildflower​


Accepted Insurance

The Lactation Network (TLN)
If you have BCBS PPO, Anthem PPO, United PPO, VA CCN, or any subsidiary of these plans—or if your insurance card has a Multiplan or PNOA logo on the back—you may qualify for up-front insurance coverage through TLN.
Pre-Approval Required: Use the following link to request pre-approval: Check TLN Coverage​
Important: Pre-approval must be completed before your appointment. Without it, you may be responsible for paying out-of-pocket for your visit.

Cigna
If you are insured through Cigna, you may qualify for up-front coverage through Wildflower, a contracted billing company.
Pre-Approval Required: Use the following link to request pre-approval: Check Wildflower Coverage​
Important: Pre-approval must be completed prior to your appointment. Without it, you may be responsible for paying out-of-pocket for your visit.

Aetna
Rooted Maternal Wellness is in-network with Aetna, and you may qualify for insurance coverage for lactation consultations.
Coverage Changes: Starting March 2024, Aetna no longer covers six full consultations for the lactating parent. Instead, they cover six codes. Each consultation requires two codes—one for the parent and one for the baby—effectively covering three consultations.
Primary Insurance Requirement: To file claims, both you and your baby must have Aetna as your primary insurance.
Out-of-Network Baby Coverage: If your baby is covered by an out-of-network plan, we will bill Aetna for your portion but will require a $125 payment per visit for the baby’s portion.
Denial of Coverage: If Aetna denies coverage entirely, you will be responsible for the full self-pay fee. A superbill will be provided for potential reimbursement.
Exceeding Coverage: If you use all six covered codes and need further support, contact us to explore additional options.

Out-of-Network Insurance
Self-Pay Rates: $300 for the initial visit, $200 for follow-ups. 
Partial Insurance Coverage: If you are on a in-network insurance but your baby is on an out-of-network plan, the self pay rate for the non-insured half: $125. A superbill will be provided for you to submit for potential reimbursement.

A superbill will be provided for you to submit for potential reimbursement.

 For out-of-network primary insurance, full payment of the self-pay fee is required upfront. Refunds are only issued if Rooted Maternal Wellness receives direct payment from your insurance, and only for the exact amount received.


General Policies
Client Classification: You and your baby are considered a collective client. The initial visit includes one week of follow-up support through secure messaging, email, or text. Continued support is available for an optional weekly fee, which is not eligible for insurance reimbursement.
Travel Fees: If applicable, travel fees are not eligible for insurance reimbursement.
Verification Responsibility: Rooted Maternal Wellness can confirm basic insurance coverage but cannot account for special circumstances or exclusions. If claims are denied, you are responsible for the self-pay rate.

Rooted Maternal Wellness may communicate with your insurance provider regarding services provided and with your credit card company or bank for payment-related matters. You are responsible for providing accurate and current payment and insurance information and for updating your credit card details as needed. Any costs or fees resulting from failure to provide updated information are your responsibility.

These policies apply to Rooted Maternal Wellness and its representatives.

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