Bayou City Breastfeeding Payment Policies

NOTICE OF PAYMENT POLICIES 
EFFECTIVE DATE: 5/1/2024

THIS POLICY DESCRIBES OUR PAYMENT POLICIES. PLEASE REVIEW IT CAREFULLY.

SELF-PAY (OUT OF NETWORK) CLIENTS: Bayou City Breastfeeding (BCB) will provide you with a superbill to send to your insurance for reimbursement. We do not guarantee that your insurance will reimburse you for your visit. You agree to always keep a valid credit card on file and to have your visit charged to your credit/debit/FSA/HSA card within 2 business days of the visit.  We offer a timely payment discount for visits paid within 2 business days of services.

INSURANCE BILLING ON BOTH PARENT AND CHILD: BCB provides care for you and your baby or babies; together you are all the clients of BCB. If you are using insurance benefits, BCB will submit a claim on behalf of you AND your babies. If one of you (parent or baby) is on different insurance and therefore out-of-network for BCB, you agree to pay BCB's out-of-network fee for each visit.

COST SHARING AND COPAYS: COST SHARING AND COPAYS:ACA-Compliant Plans: If your plan is subject to the ACA but applies cost-sharing to your baby's claim, we will collect the expected cost-sharing amount upfront on the day of the visit. We will submit one appeal on your behalf, and if the appeal is successful or the insurance covers these costs, BCB will issue a refund.

  • For Non-ACA Compliant Plans: An appeal will NOT be automatically filed, and we will collect any cost-sharing amounts upon receipt of the Estimation of Benefits (EOB) by BCB.
  • Immediate Collection of Expected Copays: For all insurance plans with known copay amounts, BCB will collect these amounts upfront on the day of the visit. This proactive approach ensures clarity and reduces the burden of unexpected charges later. Should the insurance pay or if appeals are successful, refunds will be issued accordingly.

SPECIAL SECTION FOR BCBS PLANS (EXCLUDING BCBS FEDERAL, BCBS UT HEALTH SELECT, AND ANTHEM): For clients insured under BCBS plans—except for BCBS Federal, BCBS UT Health Select, and Anthem—BCB has observed that these plans typically apply a cost-sharing amount to services. To streamline our billing process and ensure clarity for our clients:

  • Expectation of Cost-Sharing: We expect a cost-sharing amount to be applied to claims under these specific BCBS plans.
  • Upfront Collection: BCB will collect the anticipated cost-sharing amount upfront on the day of the visit. This policy is aimed at reducing the delay and uncertainty associated with the claims processing period.
  • Refund Policy: Should our subsequent appeals to your insurance result in the coverage of these costs, or if the insurance pays these charges directly, BCB will issue a prompt refund of the collected amounts.

PRIMARY AND SECONDARY INSURANCE: If you have different primary insurance that is out-of-network for BCB, you must pay the full self-pay fee upfront as a deposit. You will not be refunded any amount either insurance plan applies to cost sharing. Refunds will only be issued after BCB receives finalized EOB’s and payment directly from insurance(s) and only for the specific amounts paid by your insurance(s). BCB may keep any amount paid by your insurance(s) over and above the deposit you paid.

TRAVEL FEES: If your location has a travel fee applied, this is not eligible for insurance reimbursement. If you submit a superbill for this charge, the BCB claim may be denied. In this case, you will be liable for paying the full self-pay fee to BCB.

VERIFICATION OF BENEFITS: You are responsible for verifying your own lactation benefits. BCB can only see that you have benefits; we cannot see if you have any special circumstances or plan restrictions that might prevent your insurance provider from covering services. It is your responsibility to verify that the Lactation Consultant is in-network with your specific plan and that your plan does not have limitations or restrictions that would prevent services from being covered. It is your responsibility to verify coverage and eligibility, including any pre-certification or referral requirements for your plan.

CLAIM DENIALS: If your plan denies coverage of lactation services after the claims have been submitted, you will be responsible for paying at the self-pay rate if payment is received within 2 business days (required to qualify for timely payment discount). You should refer to your plan benefits and call your insurance directly to verify lactation coverage.

HIPAA (Health Insurance Portability & Accountability Act) AND COMMUNICATION: BCB will communicate with your insurance company in reference to the services provided to you and your baby or babies, including release of information to your insurance company, The Lactation Network, Wildflower, any third-party biller used by BCB, any State Department of Insurance, the Department of Labor, the CMS Hearing Officer, or to contact the employer sponsor for your plan if you have a self-funded insurance plan. You agree to allow us to release your information to these entities as needed for your insurance claims.

BCB will communicate with your credit card company or bank for any payment-related matters. You must provide accurate and current payment and insurance information. You agree to update your credit card information as needed and are liable for any costs and fees associated with your failure to supply updated information.

These policies apply to Bayou City Breastfeeding LLC, its representatives, and employees. A copy of these policies will be provided upon request.