Medical Disclosure/ Additional Information for Home Visits

Dear Parents,
For the first visit:

•  1-2 hours for a Mom/ Baby history
• Assess weight, feeding, latch, breasts as needed
• Develop a plan of care addressing the concerns 
• Follow up visits may be needed- usually 1 hour

Insurance: 

•  I am currently “In Network” with AmeriHealth, AmeriHealth Administrators + Independence Blue Cross, Independence Administrators and Aetna, if your plan offers Lactation Benefits. This allows direct billing..    
• Very recently, coverage for Home Visits has changed by at least 50%. In these instances a first visit, one time only travel fee of $75.00 is requested, even if you would like additional visits.
• Other insurances are Out of Network  and the fee should be covered by reimbursement to you per the ACA.  
• Self pay - when your insurance does not offer the benefit.                                                                        

Basic Fees

• The initial home visit is $175.00 
• Subsequent visits (Follow ups) are $100.00. 
• HIPAA Compliant Video Conferencing (Telehealth) for urgent concerns is available and is $100.00.

 
*PLEASE, talk with me if special arrangements are needed. I believe a Family should have the breastfeeding/ feeding support they need and I will do my best to accommodate this.

 Options:

• Checks, cash and credit/debit cards are accepted.
• Square Up Program Electronic Invoice (email) 
• Venmo (Cell phone App)  (@njfamilyroots) is an additional option.

Kind regards,
~Debbie Chalk RN, IBCLC, CPD




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 Certifications & Associations

​International Board Certified Lactation Consultant 
Registered Nurse 
Certified Postpartum Doula 
CAPPA Certified Doula 
​Adult/Infant CPR Certified