Q: Is Bayou City Breastfeeding an in-network provider?

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).

Q: What if mom and baby have different insurance carriers?

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.

Q: Do I need to do anything for insurance coverage or get a referral prior to my visit?

Yes! An authorized referral is required for both mother and baby. We will send you exact referral details for your providers in a message during the verification process. 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).

Q: Why do I need to provide a credit card before my appointment?

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

Question 1

Is Bayou City Breastfeeding an in-network provider?

Accepted Answer

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).

Question 2

What are the referral requirements for my plan?

Accepted Answer

An authorized referral in the KelseyCareLink Online system is needed for both mother and baby.

Please choose a provider from this list based on where you would like to be seen.
- Karen Zacharias- Enax 1871050823 Magnolia
- Kyna Patrick 1518256197 Cypress Home Office
- Ariel Brewer 1134570815 Houston
- Melissa Carrera Gonzalez 1356014807 Houston
- Kathy Lenert 1528715208 Houston
- Kristin Ramirez 1467186171 Jones Rd
- Lisa Smelek 1225702749 Jones Rd
- Katelyn Kleiber 1487391140 Jones Rd
- Brandy Lightfoot 1467041673 Katy
- Karen Swan 1154052694 Katy
- Donique Trotter 1194472803 Katy
- Ali Flores 1073123428 Kingwood
- Britni Gunter 1629746490 Kingwood
- Suzanne Juel 1750630844 Kingwood
- Mandy Wilson 1134871775 Magnolia
- Megan Abbassi 1629667712 San Antonio/Houston
- Tessa Gardin 1285087783 North Spring Home Office
- Tiphany Illyes 1023673829 Webster/ West NASA
- Jennifer Robert 1396481008 Webster / West NASA
CPT coding information for the referrals:
- Mom:
  - Diagnosis Code: Z39.1
  - CPT Codes for mother: 99205, 99345, 99417, and S9443
- Infant:
  - Diagnosis Code: Z76.2, Z76.89
    - CPT Codes for Infant: 99204, 99345, and S9443
Number of Visits Requested: 6
Refer To: Provider at Bayou City Breastfeeding
Group NPI: 1376056085

Question 3

What is the difference between an in-network and out-of-network provider?

Accepted Answer

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.

Question 4

What if mom and baby have different insurance carriers?

Accepted Answer

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.

Question 5

What about Out of Pocket costs?

Accepted Answer

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.

Question 6

Are there situations where my insurance won't cover lacatation visits?

Accepted Answer

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.

Question 7

Do I need to do anything for insurance coverage or get a referral prior to my visit?

Accepted Answer

Yes! An authorized referral is required for both mother and baby. We will send you exact referral details for your providers in a message during the verification process. 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).

Question 8

Why do I need to provide a credit card before my appointment?

Accepted Answer

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

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