Bayou City Breastfeeding Payment Policies
NOTICE OF PAYMENT POICIES
EFFECTIVE DATE: JANUARY 1, 2023
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. You agree have your visit charged to your credit/debit/FSA/HSA card within 2 business days of the time of the visit.
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.
Claims for your care will be sent directly to your insurance company. The Affordable Care Act (ACA) states that lactation services are preventive and not subject to cost sharing; however, not all plans are subject to the ACA. If your plan is subject to the ACA and the plan applies cost-sharing to your claim, we will submit one appeal for you and wait to receive the final Estimation of Benefits (EOB) before collecting any cost-sharing amounts. If you have a self-funded, ERISA (Employee Retirement Income Security Act), and other plan that does not comply with the ACA, 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.
If any part of either the parent or babies’ claims are applied to cost-sharing, you understand that you are required by law to pay cost-sharing to BCB, and we are required by law to collect these fees. If your insurance provider applies any portion to deductible, coinsurance or copay and our appeal attempt is unsuccessful, BCB will charge your credit card on file. If that charge is unsuccessful for any reason, you will be invoiced, and you agree to pay within 7 days for all applied charges for all visits. If our appeal is successful and we have already charged you for cost-sharing, you will be refunded any amount of the cost-sharing that BCB recovers from your insurer.
PRIMARY AND SECONDARY INSURANCE:
If you have different primary insurance that is out-of-network for BCB. You understand that you must pay the full self-pay fee up front as a deposit. You will not be refunded any amount either insurance plan applies to cost sharing. You will only be refunded 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.
If your location has a travel fee applied, you understand that this is not eligible for insurance reimbursement. If you submit a superbill for this charge, the BCB claim to 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.
If your plan denies coverage of lactation services after the claims have been submitted, you will be responsible to pay at the self-pay rate. 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, Ashland Health (The Lactation Network), any third-party biller used by BCB, any State Department of Insurance, the Department of Labor, the CMS Hearing Officer or to submit a request for external review on your behalf with the Federal Maximus program. 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 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.