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. 

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In-Network: Aetna, Ambetter, BCBST & United HealthCare
Certified Provider: Tricare

  • 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, United HealthCare, Ambetter 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.

  • Why should I see an in-network provider?

    • We have found that clients have better benefits when seen by an in-network provider, including unlimited visits for some payers.  Some payers, like Ambetter, will only pay if you use a provider in-network.  We have chosen to pursue in-network to relieve the paperwork hassle on our end, and to give clients long term support, beyond latch. In other words, support groups are often included in your benefits!​

  • 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, Ambetter, Aetna or UHC. 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.

    • Tricare:  We are a certified Tricare provider, which means we have satisfied the criteria set forth by Tricare to be accepted by them.  We are not "in-network" at this time.  

    • Cigna: We are able to send claims on your behalf for reimbursement and have figured out a code they will pay for consistently.  It does not cover the entire visit fee, so you will be charged a partial fee for the visit.  

    • 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. At this time we are not accepting Tenncare clients due to schedule availability.  We recommend using the resources provided by WIC, or the Tennesee Breastfeeding Hotline.

    • All other plans  In the past year or so, more companies have understood the importance of covering breastfeeding support.   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 $125 to $200.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. We can accept HSA cards as well.

  • Do you offer home visits?

    • ​At this time we are not offering home visits.  We find that we can see more clients and offer a higher quality of service if moms are able to come to us. 

  • I am not able to get to your office, may I see you by telehealth?​

    • We would love to explore telehealth as an option for you. Telehealth visits may be covered by your insurance plan and are a great way to get care if you are not able to come to our location.  We have a secure site that is easy to use from your phone or laptop.  This option can be used as a bridge until you are able to travel to our location, or as a follow-up plan once care has been established.

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.