Breastfeed Atlanta is committed to promoting optimal health by increasing access to care for lactation, postpartum, and newborn care services. Our goal is to bill third party payors, including insurance plans and Medicaid, whenever possible to minimize out of pocket costs to families. To help us streamline our processes and practices whenever possible to conserve costs, we will ask you to help us by promptly providing all insurance information requested. In an effort to maintain transparency, we will provide an estimate of costs prior to rendering services whenever possible. Questions about billing and insurance coverage can be sent via email to billing@breastfeedatlantallc.com.

Please use the links below to access additional information about insurance, billing, and our practice policies.

In-Network Insurance
Out-of-Network Insurance
Self-Pay Patients
Prompt Pay Discount
Payment Policy
Cancellation Policy
Delinquent and Collections Accounts
Definitions of Common Insurance Terms
Insurance FAQs
Credit Card Policy
Consent for Treatment
HIPAA Disclosures
Financial Policy and Practices

We are in-network with most commercial insurance payors and all Georgia Medicaid CMOs. We agree to accept assignment for any insurance plan with which we are participating providers, and will file insurance claims on your behalf. CO-PAYMENT, CO-INSURANCE, AND DEDUCTIBLES ARE DUE AT THE TIME OF SERVICE. Your benefits coverage is based on your plan with your insurance plan, and it is your responsibility to be knowledgeable of your benefits. We ask that you contact your insurance plan prior to your visit with us and follow-up with your insurance plan in the event of any dispute or issues regarding amounts due by you. We are considered in-network for most, but not all plans, with the following payors:

Aetna
Ambetter
Amerigroup (Medicaid)
Anthem/Blue Cross Blue Shield
Caresource (Medicaid)
Cigna
Humana
Medicaid (GA Families and Pregnancy plans only)
Meritain
Peach State Health Plan
TriCare
UHC
UMR

“Out-of-network” means we have not signed a contract with the health plan and we are not able to file insurance claims on your behalf. You may email the billing team (billing@breastfeedatlantallc.com) to request a superbill after your visit so that you may file a claim with your insurance company. Breastfeed Atlanta is not able to guarantee any out-of-network insurance benefits and encourages patients to confirm available coverage prior to your visit.

If you do not have insurance or have insurance that we can not bill directly, you will be offered a prompt-pay discount and payment is expected in full at the time of service.

The rates listed below are applied to each patient for whom care is provided. Babies and their parent are each considered to be a separate patient. For example, one mother and one baby are counted as two patients, a mother who comes to an appointment alone is counted as one patient, a mother and twins are counted as 3 patients. These rates reflect the cost of the usual and customary services provided, usually 30 minutes per patient. Sometimes, a patient’s clinical presentation may require additional services not covered by these rates.. Additional charges will apply in those situations. Examples of additional services: labs, consultations and/or coordination of care with other healthcare providers, medications, medical equipment, special procedures/treatments, or extended length of time required for care.

• Lactation office visits: $75 per patient

• Lactation home visits: $125 per patient

• Newborn Clinic visits: $175 per baby

• Lab test: varies depending on specific test

Payment is expected at the time of service. We accept cash and credit cards including American Express, MasterCard, Visa and Discover.

You may cancel/reschedule your appointment without penalty if you give at least 24 hours notice. Appointments canceled/rescheduled with fewer than 24 hours notice will result in a “no show” fee of $75, charged automatically to the card on file, and may result in dismissal from the practice. During normal business hours, you may cancel/reschedule your appointment by calling the office at 404-454-9715. Outside normal business hours, you may request to cancel/reschedule your appointment in writing by emailing info@breastfeedatlantallc.com.

According to the card on file agreement, all previously unpaid amounts deemed “patient responsibility” after insurance claims have been completely processed will be charged to the card you put on file AFTER you have been notified and offered the option to make alternative arrangements. If you do not have a valid card on file, you will receive up to two (2) statements for any balances on your account after the payments and adjustments have been applied. Breastfeed Atlanta may decline to provide further services until delinquent amounts are paid. Any unpaid delinquent debt (no payment received after 60 days from the time services were rendered), including no-show fees, owed to Breastfeed Atlanta may be referred to an outside collection agency. You are responsible for all additional collection agency expenses incurred by Breastfeed Atlanta in the course of obtaining payment. The collection agency expense could be as much as 50% of the outstanding balance.

Deductible: the amount you have to pay for a service that is covered by your plan before your health insurance goes into effect

Copayment (Copay): the set amount you pay for a service or prescription drug

Coinsurance: the percentage of the cost you have to pay for a service covered by your plan; for example, if your coinsurance is 20%, you pay for 20% of the cost, and your insurance pays for the remaining 80%

Out-of-Pocket Limit: the most you will need to pay in a single year for any service that is covered by your plan

Prompt-pay discount: a specific discounted amount offered to patients who have no health insurance, out-of-network insurance, or plans with a very high deductible. This discount is offered because payment is made in full at the time of services, rather than after the time required to file an insurance claim. Note that Breastfeed Atlanta will not file any insurance claim for services that are paid for using the prompt-pay discount.

Out-of-network: providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service.

Why do I have a copay? I thought lactation is supposed to be free through my insurance.
The Affordable Care Act (ACA) requires that all new health plans cover lactation support and supplies without cost-sharing, however, there are many exceptions to this rule. Some employer sponsored plans (meaning health insurance through your job) may be considered exempt from the ACA if it is a “grandfathered” plan or a self-funded plan, which allows them to be exempt from the Affordable Care Act requirements for lactation coverage. In-person lactation visits (office and home visits) are considered preventative health for mom and baby and typically do not require patient cost-sharing (copay/coinsurance). If your specific policy does not include preventative health benefits, or your preventative health benefits have been exhausted, you may be billed for patient cost-sharing. Insurance companies process virtual visits as a specialist visit for both mom and baby and patient cost-sharing may apply.

I have received a good faith estimate. Do I have to pay this before my appointment?
Yes. In general, all payments are due before or at the time of services. Under certain circumstances and at the sole discretion of Breastfeed Atlanta, you may be offered the option to defer payment for certain charges until after your insurance claim has been processed.

What can I do if I disagree with my good faith estimate?
Your insurance company provides the information we use to calculate a good faith estimate, so you should call them and ask. It is important to understand your benefits before receiving care.

What should I ask my insurance company when I call my insurance company?

• “Can I have your name, agent ID and a ticket number for this call?”

• “Is my insurance plan subject to the Patient Protection and Affordable Care Act?”

• “If my insurance plan is not subject to the Patient Protection and Affordable Care Act, can you tell me why that is?”

• “Where/how can I get the lactation services I am entitled to under section 1001 of the Patient Protection and Affordable Care Act which entitles me to certain preventive services with no cost sharing such as comprehensive lactation support and counseling?”

What information should I have available when I call my insurance company?

• Your policy information including member ID and group ID

• Name of practice/provider: Breastfeed Atlanta (note that BREASTFEED is one word.)

• Breastfeed Atlanta’s Tax ID: 81-0992306

• Breastfeed Atlanta’s NPI: 1558722215

• Service location type: 11 for office visits; 12 for home visits

• Diagnosis codes typically used for BABIES: P92.5, R63.3

• CPT codes typically used for BABIES: 99404, S9443

• Diagnosis codes typical used for MOTHERS:  Z39.1

• CPT codes typically used for MOTHERS: 99404, S9443

Does Breastfeed Atlanta engage in balance billing?
No. “Balance billing” is asking the patient to pay the difference between our normal fee and the insurance company’s normal payment. That’s a breach of our managed care contracts. What we charge to the patient’s credit card is the portion the insurance company has determined is not covered by the company.

Breastfeed Atlanta requires that a valid Credit Card be kept on file. The policy is designed to:

• Help avoid all billing related fees

• Streamline the billing process in our office and eliminate the expenses related to handling overdue accounts

• Allow us to focus our time and energy on you and your baby’s care.

How the policy works:

• At the time of scheduling, you will be asked for your credit card information to be electronically stored in encrypted form in our billing system. Only the last four digits are visible to our staff.

• Your signature will authorize the card to be used for all charges not covered by your insurance, including co-pays, deductibles, co-insurance, patient responsibilities, DME items, services not covered by insurance and no-show fees.

• If applicable, we will bill your insurance carrier as a courtesy for all charges related to the visit. When we receive an explanation of benefits (EOB) form your insurance, we will send you an invoice due 7 days from receipt. During this time you may review the charges, call your insurance company to ask questions, or call our office to use a different form of payment. On the 7th day, unless we have heard otherwise from you, we will charge the credit card on file for the balance due (on invoice).

Please remember that this policy does not restrict your right to appeal any charge made to your credit card. Should you feel that we have charged your card in error, you may contact our office ASAP. If a mistake has been made, we will reverse the charges. Medicaid members may opt out of this policy.

I have reviewed and agree to the Breastfeed Atlanta Credit Card on File, Health Insurance Plan, Georgia Medicaid and Cancellation Policies. I agree to provide my credit card information to Breastfeed Atlanta for the sole purpose of payment for charges related to our care. I have the right to cancel this process and use another form of payment. Until further notice, I authorize Breastfeed Atlanta to charge the patient-responsible balances on my account to the credit card I have provided.

 Credit Card On File FAQs

What is a Deductible and How Does It Affect Me?

An annual deductible is the dollar amount you must pay out of pocket during the year for medical expenses before your insurance coverage begins to pay. For example, if the policy has a $500 deductible, you must pay the first $500 of medical expenses before the insurance company begins to pay for any services.

When do I have to pay for services?

Any time you receive medical care, you are expected to pay in full for your services until your deductible is met. Our contract with your insurance company expects us to collect the patient’s portion at the time of service. If during the claim adjudication process we receive any unexpected information regarding your payment responsibility, we will promptly notify you to give you an opportunity to address any concerns with your insurance company before we charge your credit card, which in any case will be within 7 days from notice.

Why am I being singled out? I always pay all my bills.

All patients are required to keep a credit or debit card on file. This policy isn’t personal; we apply it equally to all of our patients. By doing it this way, the temptation to play favoritism is eliminated and it removes us from the uncomfortable situation of having to decide who has to follow the policy and who does not.

What about identity theft and privacy?

Under HIPAA, we are under strict rules and guidelines in terms of protecting patient privacy and the credit card is considered protected health information. Because of HIPAA rules, our medical office is far more secure than most retail establishments as it relates to identity theft. We use a secure gateway that is completely compliant as required by law. The staff has no access to your actual credit card number once stored in the gateway.

I don’t have a credit card.

You are welcome to leave a debit card, HSA (Health Savings Account) or Flex Plan card on file or pay with cash or check for the visit in full. We understand there are legitimate reasons you might not have a card (declared bankruptcy, maxed out, or declared unworthy of credit). If this is the case, we will work out a payment plan with you.

Isn’t this the same as “signing a blank check”?

You will always be informed and offered an opportunity to make alternative arrangements before your card is charged. What we are doing is similar to what hotels or rental car companies do at each check-in. Additionally, all credit card contracts give cardholders the right to challenge any charge against their account.

On behalf of the patient, I consent to the rendering of Medical Treatment/Services as considered necessary and appropriate by the Breastfeed Atlanta (BFA) healthcare team. Medical Treatment/Services may be performed by "Healthcare Professionals" (physicians, nurses, lactation consultants, lactation counselors, technicians, physician assistants or other healthcare professionals). Patient authorizes the attending or other practitioner, the medical staff of BFA and BFA to provide Medical Treatment/Services ordered or requested by attending or other practitioner and those acting in his or her place. The consent to receive “Medical Treatment/Services” includes, but is not limited to: physical examinations; phlebotomy or other laboratory specimen collection procedures; medications; infusions; medical treatments; lactation specific treatments/recommendations; recording/filming for internal purposes (i.e., identification, diagnosis, treatment, performance improvement, education, safety, security) and other services which Patient may receive. In the event BFA determines that Patient should provide blood specimens for testing purposes in the interest of the safety of those with whom Patient may come in contact; Patient consents to the withdrawing and testing of Patient’s blood and to the release of test information where this is deemed appropriate for the safety of others.Patient acknowledges that the practice of medicine is not an exact science and that NO GUARANTEES OR ASSURANCES HAVE BEEN MADE TO THE PATIENT/FAMILY concerning the outcome and/or result of any Medical Treatment/Services. Healthcare Practitioners in Training Patient recognizes that among those who may attend a Patient at BFA are medical, nursing and other health care personnel who are in training and who, unless specifically requested otherwise, may be present and participate in patient care activities as part of their medical education. There also may be present from time to time a medical product or medical device representative. Consent is hereby given for the presence and participation of such persons as deemed appropriate by the BFA healthcare team.

On behalf of the patient/patients, I hereby authorize Breastfeed Atlanta, LLC and its affiliates, its employees and agents, to use and disclose protected health information (e.g., information relating to the diagnosis, treatment, claims payment, and health care services provided or to be provided to me and which identifies my name, address, social security number, Member ID number) for the purpose of helping me to resolve claims and health benefit coverage issues. I understand that any personal health information or other information released to the person or organization identified above may be subject to re-disclosure by such person/organization and may no longer be protected by applicable federal and state privacy laws.

I understand that I have the right to revoke this authorization by providing written notice to. However, this authorization may not be revoked if it’s employees or agents have taken action on this authorization prior to receiving my written notice. I also understand that I have a right to have a copy of this authorization. I understand that information used or disclosed pursuant to this authorization may be disclosed by the recipient and may no longer be protected by federal or state law. I further understand that this authorization is voluntary and that I may refuse to sign this authorization. My refusal to sign will not affect my eligibility for benefits or enrollment or payment for or coverage of services. I have been advised of this practice’s Privacy Practices, Release of Billing Information policy, Assignment of Benefits policy, and grant the practice Medication History Authority.

I assign any right I may have to receive payment from a health insurance plan, ERISA, Medicare, Medicaid, Social Security or other payor(s) for services rendered by Breastfeed Atlanta and the medical professionals caring for me during my treatment. I understand that I am financially responsible for all healthcare services, including amounts that are not covered by my health insurance plan or payor, as appropriate, based on the terms of the health plan contracts or the law. For example, non-covered services, deductibles and copayments are the patient’s responsibility. For healthcare services provided by independent medical professionals, I understand that I will receive separate bills and that I am responsible for paying them. I agree to provide BFA with all health insurance coverage information if I choose to use my insurance for payment of services. I agree to respond to all requests for benefit information and complete any forms required by my insurance plan. I authorize Breastfeed Atlanta and its medical professionals to submit appeals for payment, including arbitration and formal complaints, on my behalf as required by my insurance company. I also understand that I am financially responsible for collection costs if my account becomes delinquent and that all delinquent accounts will be interest at the legal rate unless prohibited by law. I understand that BFA may request and use data from third parties such as credit reporting agencies in order to verify demographic data or evaluate financial options.

For Patients Insured by Medicaid

I certify that the information given by me in applying for payment under Title XVII and XIX of the Social Security Act is correct. I authorize the release of any information needed to act on this request. I request that payment of authorized benefits be made on my behalf. I assign payment for the unpaid charges to BFA or independent medical professionals providing healthcare services to me. I understand that I am responsible for any remaining balance not covered by other insurance. If I am signing this form and am not the patient, I understand that I am also responsible for and agree to pay charges not covered by the assignments made in this form.

Georgia Medicaid

If your child has Georgia Medicaid (Medicaid/Peachcare, Wellcare, CareSource or Amerigroup) and is also covered under a private health insurance, we are required by law to file claims with the private insurance policy first. Georgia Medicaid plans are always considered as secondary insurance. If Georgia Medicaid is not informed that your child also has private insurance, they have the right to deny reimbursement of claims and to retract payment from previously paid claims. If this occurs, then the entire balance will be the responsibility of the parent/guardian on file.

Authorization

• I hereby certify that the information I have provided regarding my and my child/children’s insurance, our address and phone numbers is correct.

• I understand that fees charged are due at the time of services and are ultimately my responsibility, regardless of insurance.

• I hereby authorize Breastfeed Atlanta to apply for benefits of myself and my child/children for covered services rendered.

• I request payment from my insurance carrier be made directly to Breastfeed Atlanta.

• I authorize the release of any medical information necessary to process insurance claims.

• I permit a copy of this authorization to be used in place of the original. This authorization may be revoked by either my insurance carrier or me at anytime by submitting a request to Breastfeed Atlanta in writing.

• I acknowledge by my signature that I have read and do understand this financial policy and authorization.

• I also acknowledge that I will be responsible for payment of services, co‐pays co‐insurances,

• I acknowledge that I will be responsible for payment of services, copays, coinsurances, deductibles or services not covered by my insurance company.