Policies for Clients With KelseyCare Health Plans Insurance

Bayou City Breastfeeding is not in-network with Kelsey Seybold. However, we are authorized affiliate providers. 

All Kelsey Seybold plans require specific referrals to be seen. (See details below).

An authorized referral in the KelseyCareLink Online system is needed for claims processing. 

• CPT coding information for the referrals:
  • Mom:
    • Diagnosis Code:  Z39.1
    • CPT Codes for mother:
    • 99404: 12 units, S9443 12 units, 98960 36 units 
    • Number of visits 12
  • Infant (not on the same policy as mom):
    • Diagnosis Code: Z76.2, Z76.89, Z71.89
    • CPT Codes for Infant: 99404: 12 units, S9443 12 units, 98960 36 units 
    • Number of visits 12
• Refer To: Provider at Bayou City Breastfeeding
• Group NPI: 1376056085

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.

If we can't bill an insurer for either the parent or baby, you’ll need to pay a non-covered patient fee: $60-90 min+, $50-45 -60 min and $40-30 min appointment.  

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.

Cancellation fees and travel fees for home visits are not billed to insurance. These are billed to the card on file within 24 hours of your appointment/ cancellation. 

KelseyCare can authorize/ cancel your authorizations/ referrals at any time without notice to the provider. Unfortunately, if this happens, and your claim is denied, you will be billed at our discounted cash pay rates. 

Yes! An authorized referral is required for both mother and baby.

Both referrals need to be exactly correct, or your claims will be denied, and you will be billed at our discounted cash pay rates. Please keep in mind this is typically not a quick process, and some providers will not do referrals for you at all. Both referrals need to be done within the online Kelsey CareLink portal to be authorized and accepted by your insurance. (Our referral document is below for providers). 

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