Lactation Coverage for Cigna in Houston and San Antonio

Bayou City Breastfeeding is not in network to bill Cigna directly. We do have a few options: 

• We can bill most Cigna PPO plans through either of our two partners (The Lactation Network or WildFlower). 
• Bayou City Breastfeeding is not in-network with Cigna HMO plans, and therefore, clients with HMO plans will need to be self-pay.
• If neither of these partners can bill your plan, we can check your plan to see if you have out of network benefits and have met your deductibles. We do offer timely payment discounts. If your deductible has been met you will be billed at our discounted cash pay rate and we will file a courtesy claim on your behalf. 

An in-network provider has a contract with your insurance company and agrees to provide services at a contracted rate, which is usually discounted.  An out of network provider does not have a contract with your insurance company and may charge any rate for their services.  Some plans cover out of network providers and other require you to see an in-network provider.

https://www.cigna.com/knowledge-center/in-network-vs-out-of-network

If we can't bill an insurer for either the parent or baby, you’ll need to pay a non-covered patient fee: $80 for the parent and $60 for the baby.  

If we can bill insurance for both patients,  you might also pay extra if the plan:

• Doesn't cover lactation visits billed to the baby's plan.
• Puts a cap on the number of visits and you've used them all up for either the baby or the parent.
• Adds copays, coinsurance, or deductibles to the baby’s claim.

To keep providing our services, we need to submit insurance claims for both the parent and the baby each time they visit. This is necessary because most insurance plans don't fully cover claims that only include the parent. The Affordable Care Act says insurers must cover lactation services for the lactating parent without any out-of-pocket costs, unless the plan is old (grandfathered). However, this doesn't cover your baby's lactation services, which might lead to extra costs for your baby's claim at each visit—even if your insurance usually covers lactation visits.

Here’s when you might have to pay extra:

• If we can't bill an insurer for either the parent or baby, you’ll need to pay a non-covered patient fee: $80 for the parent and $60 for the baby.
• Depending on your insurance plan, you might also pay extra if it:
  • Doesn't allow us to claim for both the parent and child on the same day.
  • Doesn't cover lactation visits billed to the baby's plan.
  • Puts a cap on the number of visits and you've used them all up for either the baby or the parent.
  • Adds copays, coinsurance, or deductibles to the baby’s claim.
  • Isn't in-network with the baby’s insurer.

If your insurance covers the baby, the charge for their part of the visit will usually be between $60 to $80, depending on your plan

1. Parent is not lactating or attempting to lactate anymore (they have switched to all formula feeding)
2. The plan is a grandfathered plan
3. The plan is a self-funded plan that specifically excludes lactation
4. The plan only covers lactation services as an inpatient service (in the hospital)
5. The plan only covers lactation when provided by a nurse practitioner, midwife or medical doctor

We do not need referrals for our Cigna patients. We will use the information you provided on our insurance intake form to submit your policy to our partners. 

Bayou City Breastfeeding is not in-network with Cigna HMO plans, and therefore, clients with HMO plans will need to be self-pay.

We require that all patients have a valid card on file to secure the booking of their initial visit. We will not schedule your appointment without having a valid card on file. 

* You are authorizing us to save the card on file and use it to process the following fees: 

• Late cancellation / no show fees
• Home Visit Travel Fee
• Copay/ Coinsurance / Deductible
• Non covered / denied services
• Non covered patient fee for mom or baby who does not have billable insurance