Terms and Conditions of Payment for Services:
I understand that Carol Kidd, IBCLC of Connections Lactation Care (CLC) is providing a professional service in my home and that I am responsible for all charges associated with this visit and future visits. Carol Kidd, IBCLC of CLC is providing care to me and to my baby or babies; together we are the client of Carol Kidd, IBCLC of CLC.
Claims for my care will be submitted directly to Aetna, Banner Aetna, or BCBSAZ. Carol Kidd, IBCLC of CLC will make every effort to recover payment according to the Affordable Care Act which states that lactation services are preventive and not subject to cost-sharing. If my insurance provider applies any portion to deductible or coinsurance and appeal attempts are unsuccessful, I will receive an invoice for the remaining amount owed. If the invoice is not paid by the due date, my credit card on file will be charged for all applied charges for all visits.
If I cancel with less than 24 hours notice, my credit card on file may be charged $50.
If my location has a travel fee applied, I understand that this is not eligible for insurance reimbursement. Carol Kidd, IBCLC of CLC will charge $50, payable upon receipt of invoice, for any visit that is further than 40 minutes from my business address.
If my insurance provider is out of network for Carol Kidd, IBCLC of CLC, I will receive an invoice for the self-pay amount which is payable at the time of service. My paid invoice will serve as my super bill which I can submit to my insurance provider for reimbursement.
Alternatively, Carol Kidd, IBCLC of CLC can submit claims on behalf of myself and my babies for a fee of $20 to be added to my invoice upon request. I will be refunded any amount that Carol Kidd, IBCLC of CLC recovers from my insurer up to the amount I paid for the visit.
If my baby is on different insurance and therefore out-of-network for Carol Kidd, IBCLC of CLC, I agree to pay $50.00 per visit. My paid invoice will serve as a superbill which I can submit for out-of-network insurance.
If I have different primary insurance that is out-of-network for Carol Kidd, IBCLC of CLC, I understand that I must pay the full self-pay fee up front as a deposit. I will not be refunded for any amount either insurance applies to cost-sharing. I will only be refunded if and when Carol Kidd, IBCLC of CLC receives payment directly from either insurance up to the amount I have paid.
I am responsible to verify my own lactation benefits. Carol Kidd, IBCLC of CLC cannot confirm my coverage. If my plan denies coverage of lactation services after the claims have been submitted, I am responsible to pay at the self-pay rate. I understand I should refer to my plan benefits and call my insurance directly to verify lactation coverage.
Carol Kidd, IBCLC of CLC, and billers working on her behalf, may communicate with my insurance company in reference to the services provided to me and my baby or babies. Carol Kidd, IBCLC of CLC may communicate with my credit card company or bank for any payment related matters. It is my responsibility to provide accurate and current payment and insurance information. I will update my credit card information as needed and am responsible for any costs and fees associated with my failure to provide updated information.
These policies apply to Carol Kidd, IBCLC of Connections Lactation Care and its representatives.