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Appointment Request

Getting an appointment is simple!
Step 1: Tell us what type of appointment you need
Step 2: Choose to use insurance or self-pay
Step 3: Submit your insurance information for verification
Step 4: We do the rest and contact you to get you scheduled!

Step 1 of 4

Step 2: Choice your insurance to verify or choose to be self-pay

How do you plan to pay for your visit?

You may choose to self-pay for your visit. Please see our Cash Pay Price List for information on our Timely Payment Cash Pay rates.

We do offer a payment plan if needed, and can accept HSA or FSA cards for payment.

Insurance Company Name

Name of Insurance Company

Would you like us to verify your insurance coverage?

United Healthcare Plan Name

You will find your plan name on the front of your member ID card in the bottom-right corner

BCBS Prefix

Your BCBS member ID should start with a 1-3 letter prefix.

Does your member ID start with any of the the following prefixes:
AJK, AJC, ATO, CGO, CGOU, DMY, EAD, FVL, IEL, JEA, JSA, KEX, LAR, LCB, LSD, LZR, LLTFF, MOE, NEC, NEI, PBQ, PBU, PPA, PPP, PSC, R, SBF, SFI, SIU, SMW, TEA, TEW, TMV, TSI, UOE, UTS, UUX, XOG, XOH, XOU, YET, YLS, ZCD, ZCL, ZCS, ZGP, ZGN

BCBS Plan Type

We currently have a few IBCLCs who are in network with BCBS, please continue submitting your information, we will be happy to verify if we are in network with your plan..

BCBS insurance verification usually takes 1-2 business days.

If you have an HMO plan, please reach out to your providers (OB/GYN or Midwife AND Pediatrician) and ask for a referral to Bayou City Breastfeeding for BOTH you and your baby.

If we are not in network with your plan, or you choose to see one of the IBCLCs who is not yet in network with BCBS, you should expect to pay out of pocket for your visit.

Cash Pay Price List

We do offer a payment plan if needed, and can accept HSA or FSA cards for payment.

Working with The Lactation Network

We can often use a 3rd party partner to allow us to see clients with Cigna, BCBS or Anthem BCBS Insurance and client who use Lactation Network have no out of pocket costs if they are approved.

Once you have completed our form, you will be directed to their site to submit your insurance information with them. If you would like to see if you can be covered through The Lactation Network, you must also complete the insurance submission on their website to have your insurance verified.

The Lactation Network is usually able to verify insurance coverage within in 1 business day.

We are most likely NOT in network with your plan, but if you choose to continue submitting your information, we will be happy to verify this for you.

You should expect to pay out of pocket for your visit.

Cash Pay Price List

We do offer a payment plan if needed, and can accept HSA or FSA cards for payment.

Medicaid Plans

Please be aware that we are NOT in network with any Medicaid plans. These plans do NOT cover lactation support services.

You will be required to pay out of pocket for your visit.

Cash Pay Price List

Bayou City Breastfeeding Grant/Scholarship Program

If you have a significant financial need, you can submit a request to receive a grant from our Bayou City Breastfeeding Grant fund to offset part of the visit fee.

Grant/Scholarship Program.

Aetna Insurance Information

We are in network with most Aetna plans except for the following:

Memorial Hermann Accountable Care Organization (ACO) Restricted Network
Aetna Better Health STAR Medicaid
Some HMO Plans
Some Marketplace Plans
Some International Plans

If you would like to verify your Aetna insurance it usually takes a business day, but if you want to schedule your appointment prior to verification, we recommend that you check to see if we are listed as in network under the Find a Doctor section on your Aetna portal.

Aetna Plan Name

Meritain

We are in network with most of the Meritain plans; however, you should verify if your specific plan covers lactation support services.

Meritain verifications can only be completed Monday - Friday, 9 AM - 5 PM CST

We recommend you get a referral from your OB/GYN or primary care provider, and a referral from your pediatrician prior to your visit. Sometimes claims with these plans are denied without a referral. This happens even when they tell us that the member has 100% coverage. Please check with your individual plan to see if a referral is required on either the parent or the baby.

Aetna CVS Marketplace Plans

Please be aware that we are NOT currently in network with any of the Aetna CVS Marketplace plans.

You will be required to pay out of pocket for your visit. We will provide a superbill for you to submit to request reimbursement from your insurance company.

Cash Pay Price List target="_blank"

Requesting GAP Coverage

To improve the likelihood of reimbursement, we recommend that you call your insurance company and ask for GAP or network deficiency coverage. (This option may take a week or longer). If they approve your request, submit this information with your claim to your insurance company.

Please note that you are still required to pay out of pocket for the services when rendered, even if your insurer pre-approves your visits.

To request GAP Coverage you will need to call your plan directly and provide the NPI number of our practice (NPI 1376056085). Once you have your GAP Coverage approved, include this letter each time you submit a claim to increase your chances of reimbursement. You should request a GAP exception for BOTH you AND your baby.

You will still need to provide us with your insurance information in the form below.

KelseyCare

We are in network with KelseyCare plans, except the United Healthcare Charter plan.

Referrals/Orders

KelseyCare requires you to have an approved referral prior to your visit. To get your referral we need you to do the following:

Contact your OB/GYN and request a referral to Bayou City Breastfeeding for a lactation support visit.

For postpartum visits, we also need a referral for your baby from your pediatrician, so please contact them and request a referral to Bayou City Breastfeeding for lactation support.

This process can 3-4 days, and we can not bill insurance for your visit without receiving approval PRIOR to your visit from Kelsey-Seybold.

Hermann Memorial Plans

Please be aware that we are NOT currently in network with any of the Hermann Memorial ACO restricted access plans.

You will be required to pay out of pocket for your visit. We will provide a superbill for you to submit to request reimbursement from your insurance company.

Cash Pay Price List

We are aware that Aetna is telling some clients that Tessa Gardin is in network; however, this is incorrect. They have her listed with an incorrect specialty and we can not bill lactation consulting services under this specialty. We have been trying to get Aetna to correct this since 2017.

Requesting GAP Coverage

Please note that you are still required to pay out of pocket for the services when rendered, even if your insurer pre-approves your visits.

You will still need to provide us with your insurance information in the form below.

Aetna Better Health STAR Medicaid

Please be aware that we are NOT in network with any Medicaid plans. These plans do NOT cover lactation support services.

You will be required to pay out of pocket for your visit.

Cash Pay Price List

Bayou City Breastfeeding Grant/Scholarship Program

If you have a significant financial need, you can submit a request to receive a grant from our Bayou City Breastfeeding Grant fund to offset part of the visit fee.

Grant/Scholarship Program.

Step 4: Submit your form and we will contact you to get you scheduled!

Schedule appointment now or wait for insurance verification?

Please contact me to schedule now

Only want to schedule if covered by insurance

Will decide after insurance is verified

We are happy to schedule you prior to verifying your insurance coverage. We will reach out to you shortly!

Please be aware that if your insurance does not cover lactation support or we are not in network with your plan, you will have to pay out of pocket for your visit and submit for reimbursement.

Cash Pay Price List

We will use the information you provided to verify your insurance benefits and send you an email with the coverage information. We may reach out by text if we need additional information from you to verify your coverage.

Insurance verification usually takes 1-2 business days to complete.

BCBS, Anthem BCBS and Cigna

You will be directed to The Lactation Network's website to submit your insurance information after you complete this form

After you submit your form, don't forget to also submit your information to our partner, The Lactation Network!

How did you hear about us?

Name of person or facility that referred you:

Contact Preference:

Please let us know how you would like to be contacted (you may select more than one method)

Would you like to sign up for our email list?

Your information will never be sold or shared. You may unsubscribe at any time.

Yes

NOTE - The form will not submit unless you check the "I agree" checkbox under the Consents below

Consents (Please read all)

Self Pay:
I understand that if I choose self pay, I will have to pay out of pocket for my visit. I understand that as a self-pay patient, I will be responsible for submitting any claims to my insurance company for reimbursement. I understand that Bayou City Breastfeeding does not guarantee that my insurance provider will reimburse me for the cost of the visits.

Insurance Verification:
If I requested to have my insurance verified, I give Bayou City Breastfeeding, LLC permission to check and verify coverage for both me and my baby with the insurance carrier. I give permission to share information about me and my baby (including name, phone number, email address, mailing address, dates of birth and insurance information) for the purposes of verifying insurance coverage for Lactation Services with The Lactation Network if appropriate.

If I requested to not have my insurance verified by Bayou City Breastfeeding, I understand that I am responsible for verifying my own insurance coverage and if my plan does not cover lactation support or if Bayou City Breastfeeding is not in network with my plan, I will have to pay out of pocket for my visit.

Scheduling before Insurance Verification: I understand that if I choose to schedule an appointment prior to insurance verification by Bayou City Breastfeeding, I am responsible for verifying my own insurance coverage and if my plan does not cover lactation support or if Bayou City Breastfeeding is not in network with my plan, I will have to pay out of pocket for my visit.

Urgent Requests for visits within 48 hours
If I am requesting to be seen within 48 hours, and I understand that Bayou City Breastfeeding may not have time to verify my insurance. I am responsible for verifying my own insurance coverage and if my plan does not cover lactation support or if Bayou City Breastfeeding is not in network with my plan, I will have to pay out of pocket for my visit.

Home Visit Fees: I understand that if I choose to have an in home visit, there is a $70 out of pocket convenience fee that is NOT paid for or billed to insurance.

HIPAA and Privacy
I have read and agree to the Bayou City Breastfeeding LLC HIPAA and Privacy Policies (https://bayoucitybreastfeeding.com/privacy-policy and https://bayoucitybreastfeeding.com/bayou-city-breastfeeding-hipaa-policy)

I agree

Name

This field is for validation purposes and should be left unchanged.

Appointment Request

Step 1: Tell us what type of appointment you need

Step 2: Choice your insurance to verify or choose to be self-pay

Working with The Lactation Network

Medicaid Plans

Bayou City Breastfeeding Grant/Scholarship Program

Aetna Insurance Information

Meritain

Aetna CVS Marketplace Plans

Requesting GAP Coverage

KelseyCare

Referrals/Orders

Hermann Memorial Plans

Requesting GAP Coverage

Aetna Better Health STAR Medicaid

Bayou City Breastfeeding Grant/Scholarship Program

Step 3: Provide us with your information for verification

Baby's information

BCBS, Anthem BCBS and Cigna

NOTE - The form will not submit unless you check the "I agree" checkbox under the Consents below