Yes, we bill insurance!

Breastfeeding help should be 100% covered as a part of the Affordable Care Act.   New mamas shouldn't have to worry about submitting superbills and fighting with their insurance companies to get help feeding their babies. Let us take that off your to-do list, so you can focus on loving and feeding your baby. 

In-Network: Aetna & BCBST 

  • Do you accept insurance?

    • It is more of a question of whether your insurance will accept us.  We are in-network with Blue Cross Blue Shield of Tennessee, and Aetna.  We have certain obligations to those companies to accept their clients, and agree to the rates they set.​  All other insurance companies we work with on a case-by-case basis.

  • I have an out-of-state Blue Cross Blue Shield plan.  Do you accept that?

    • If they list Lisa Paul as an in-network provider, we are in your network.  What we have learned is that some states pay for very little breastfeeding support, sometimes 1 visit, sometimes 2.75 hours per calendar year.  In order to confirm benefits, we suggest that you call the number on the back of your card prior to your visit​

  • What about grandfathered plans on BCBST?

    • Unfortunately, grandfathered plans do not have to follow ACA mandates. It is best to call to confirm the coverage for breastfeeding support prior to your appointment. Our experience is that they will cover one visit with a co-pay. Since we are in-network, you will qualify for the reduced rate and any uncovered amount may be applied to your deductible

  • My insurance is not BCBST or Aetna. How do you work with my insurance?​

    • If you are insured by your employer or pay independently for your insurance, we will attempt to submit an electronic claim on your behalf if your insurance accepts, or we will issue you a Superbill. Since we have not signed a contract with your insurance company, we have not agreed to the prices they may pay for our services. However, the Affordable Care Act does state that if no in-network providers exist in your area, your insurance must treat out-of-network as if they are in-network. We will do our best to get your insurance to pay according to the Affordable Care Act regulations. Please know that you will have to take an active role in this process, which could mean calling your insurance company, filing an appeal or other actions as are necessary.

    • Due to past challenges we have had with reimbursement, we now require payment at time of services for all insurance payers with whom we are not in-network.

    • UHC: In rare cases, we have been paid by UHC.  Most clients will have the amount of the visit applied to their deductible because we are out-of-network.  We have tried several times to apply for in-network status but they say they are "full".  We have escalated concerns to the state level and continue to advocate for coverage.  If you would like for us to submit claims on your behalf, we have read their breastfeeding policy and will code the superbill to give you the highest chance of reimbursement.

    • Cigna: We highly recommend you contact them prior to seeing us to make sure that they will cover out-of-network lactation consultants. Cigna claims there are 3-4 in-network providers but none of those providers do out-patient documented visits. We are able to send claims on your behalf for reimbursement.

    • Tenncare:  We understand that there are no lactation consultants in our area who can bill Tenncare.  We have tried to pursue this, and have been sent on wild goose chases between Tenncare and the insurance providers, each telling us we had to start at the other end. While we wait for miracles to happen, we have special rates for women who are on Tenncare.  Payment is required at the time of service and we will do our best to give you resources to meet your breastfeeding goals.

    • All other plans  Our experience is that very few plans are aware of the requirement to treat breastfeeding help as preventative care, especially as an out of network provider.  We can submit your insurance for you, and require payment at time of service.

  • Will you work with my ​health care share ministry?

    • ​If they accept electronic submission of claims, we are willing to submit claims on your behalf. If not, we will issue a superbill for you to submit.

  • How much does it cost for an office visit?​

    • An initial new mom and newborn baby visit typically lasts 1.5-2 hours and ranges in cost from $160 to $250.Most plans that we have worked with have covered up to 6 visits at 100%, meaning no out-of-pocket costs if we are in-network with your insurance plan. We try our best to obtain a patient cost estimate prior to your visit for those in-network clients.

    • For out-of-network clients, we will work with you before your appointment to get the best coverage. This includes pre-authorization and electronic submission of the claim. How much of that is reimbursed is dependent on your insurance company and plan.If your insurance denies the claim or says that you are responsible for part of the balance, you will be responsible for the balance.

    • If you would like to forgo submitting claims to your insurance company, we do offer discounts for packages of visits.  The discounts range from 10-30% depending upon number of visits.  More information on pricing will be shared through our portal after you make an appointment.

  • Do you take credit cards?​ 

    • ​Yes, we are set up for credit card processing through our secure patient portal. We also accept checks and cash. At this time we cannot accept HSA cards but are in the approval process to accept them soon. 

  • Do you offer home visits, phone calls or telehealth visits?​

    • ​Yes we do. Home visits are not directly covered by any insurance company so we charge an extra traveling fee for those separate from the consult. This fee would be an out-of-pocket expense for you. Phone consults are not currently covered by insurance so this too would be strictly on a self-pay basis. Telehealth visits may be covered by your insurance plan and we are able to explore that option for you

If you have questions above and beyond the ones above, we would love to chat with you about it.  Please call or text our office at (865) 344-1788.

  • Grey Facebook Icon
  • LinkedIn Social Icon
  • Instagram Social Icon
  • Twitter Social Icon

© 2019 by Knoxville Lactation Clinic