Bayou City Breastfeeding Payment Policies

NOTICE OF PAYMENT POLICIES 

Effective Date: June 19, 2025

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

 

Notice of Payment Policies

This document outlines the payment policies of Bayou City Breastfeeding. We strive to provide clear and concise billing practices to ensure seamless and transparent client experience. 

 

Self-Pay (Out of Network) Clients:

BCB will provide a superbill for you to submit to your insurance for potential reimbursement. While we do not guarantee reimbursement, we require that a valid credit card be kept on file. Charges for services rendered will be processed within 2 business days of the visit. A timely payment discount is available for payments made within this period. 

 

Insurance Billing for Parent and Child:

BCB values the health of both mother and baby, considering both as our clients. When using insurance benefits, we will submit claims on behalf of both. However, if one party is on a different insurance plan and out of network for BCB, the applicable out-of-network fee will be charged per visit.

 

Updated Policy for Specific Insurance Plans:

BCB values the health of both mother and baby, considering both as our clients. When using insurance benefits, we will submit claims on behalf of both. Certain insurers BCB cannot bill lactation claims for both mother and baby on the same date of service. If BCB is unable to file a claim on one party’s policy a NON-Covered fee will apply and will be charged per visit to the card on file. We require that a valid credit card be kept on file. Charges for services rendered will be processed within 2 business days of the visit. 

  • Initial Visits and Visits 90 Minutes or Longer: $60
  • 1-Hour Visits: $50
  • 30-Minute Visits: $40

 

Updated Policy for Specific Insurance Plans: 

💲💲**INSURANCE AND ESTIMATED OUT OF POCKET COSTS**💲💲 

 

🛑BCBS PLANS 

- NON-COVERED Fee applies per visit fee  

- HOME VISITS not covered/CASH PAY APPLIES 

- BCBS FEDERAL will not cover Telehealth Visits 

 

🛑TLN APPROVED PLANS 

  • TRAVEL FEE applies for Home Visits 

 

🛑AETNA/ AETNA SUBSIDIARIES AND HUMANA PLANS 

These plans count the office and lactation codes on the claim as 2 visits of lactation per claim; to get full coverage for your visit, we bill an office visit code and a lactation code on the claim and Aetna counts it as 2 separate lactation codes per visit. You should expect OOP costs after the 3rd visit. If you used Aeroflow for any visits, Aeroflow may have used some of your lactation benefits and this may change the out-of-pocket cost per patient per visit. 

  • NON-COVERED fee applies per visit after lactation maxed 
  • TRAVEL FEE applies for Home Visits 

 

🛑AETNA SUBSIDIARIES  

Plans do not cover the infant due to denying the lactation code for infants’ age. 

  • NON-COVERED Fee applies per visit 
  • TRAVEL FEE applies for Home Visits 

 

🛑UHC/UMR AND SUBSIDIARIES PLANS 

Infant claims may process with a small portion applied to coinsurance/deductible/copay resulting in an estimated amount of $5.00 - $62.52 for initial and any visits over 90 min.  A finalized claim email and /or Spruce notification with the breakdown of these charges will be sent to you 24 hours before the card on file is billed. 

  • TELEHEALTH Appointments not covered 
  • TRAVEL FEE applies for Home Visits 

 

🛑CIGNA (WILDFLOWER) PLANS 

  • NON-COVERED Fee applies per visit fee 
  • TRAVEL FEE applies for Home Visits 

 

🛑AETNA GAP APPROVAL PLANS 

Plans that require participants to obtain GAP Coverage/Network Deficiency Approval PRIOR please call our Billing Team at 281-626-5271 to verify your approval is on file before your appointment. 

  • NON-COVERED Fee applies per visit 
  • TELEHEALTH Appointments not covered 
  • TRAVEL FEE applies for Home Visits 

 

🛑COST SHARING AND COPAYS  

We are required to collect any copay, coinsurance or deductible applied by your insurance company. Expected cost-sharing amounts are collected upfront and/or after the claim has finalized. Any claims that are not appropriately processed according to the plan benefits will be appealed on your behalf if applicable. You will be notified of any claim/appeal issues via text and/or Spruce app.  

  • For ACA-compliant plans, lactation services are considered preventive and are not typically subject to cost sharing for the mother. However, some plans may apply cost sharing for services related to the baby. 
  • Non-ACA compliant plans should expect to have cost-sharing and if amounts are not collected upfront, they will collect upon receipt of the EOB once the EOB payment has finalized, and it will be communicated to you via email and/or Spruce app. 

 

Travel Fees:

Travel fees are not eligible for insurance reimbursement. If a claim including a travel fee is submitted, it may be denied, and you will be liable for the full self-pay fee. 

 

Verification of Benefits:

Clients are responsible for verifying their own lactation benefits. It is crucial to ensure that our services are covered under your specific plan, including any special circumstances or restrictions. 

 

Claim Denials:

If your insurance denies a lactation service claim, you will be required to pay the self-pay rate. Payment within 2 business days qualifies for a timely payment discount. 

 

HIPAA and Communication:

BCB will communicate with your insurance regarding services provided and may release information as necessary to support insurance claims processing.

 

Contact Information:

For any inquiries or further clarification on our policies, please contact our billing department at 281-626-5271 or via email at billing@bayoucitybreastfeeding.com. 

 

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