What payment types are accepted?

 

Cash, check, credit cards, or HSA cards are all accepted.  I require a card on file when you complete paperwork and schedule, though you may pay by other means if you choose.  

 

Will my insurance cover this?

I am an OT/IBCLC and bill commerical insurance as an OT under the baby, since this is my primary role/licensure.  This means that if you plan to use insurance, the plan coverage that your baby has is what I would use for billing, if in network.

 

I do not bill insurance as a lactation consultant, but because I am an IBCLC, I address maternal lactation concerns in the context of the "big picture" of feeding for any family who is breastfeeding.   Occupational therapists have a large scope of practice, with many obtaining additional certifications  on top of their primary license to enhance their skills.  My lactation credentials qualify me to address complex lactation issues within my scope of practice as a therapist.  

 

Many insurance plans cover Occupational Therapy services.  I am in network with BCBS.

 

If you do not have BCBS,  I am currently considered an out of network provider and you would be private pay.  Fees are due at time of service delivery regardless of insurance provider.  However, an itemized invoice can be provided so that you may directly submit your bill to your insurance company for reimbursement.  If you do not plan on using insurance, you are entitled to a Good Faith Estimate re: cost of services.  I do not bill out of network claims; you are responsible for navigating claim submission/resolution with your insurance company if you choose to do so.

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"Mom only" lactation concerns, such as prenatal visits or flange fitting without any other feeding assessment, are cash pay only services that I do not bill to insurance.

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What do services cost, with and without insurance?​

Cost will vary widely if you are using BCBS insurance, dictated by your plan benefits for Occupational Therapy.

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Some patients have copays for therapy (ranging from $25-80 dollars per session), while in other plans, therapy falls under the deductible.

 

If your plan indicates a copay for therapy, you would pay the same copay every session.

 

If you have to meet a deductible first before your insurance plan will pay benefits, that can mean you may pay between $175-250 for an evaluation, and between $90-130 for follow-ups.  Deductibles are a set amount that you must pay for services before insurance will pay anything.  And many plans have two levels of deductible: family vs. individual.  If either is met (your family deductible or your baby's individual one), insurance will pay for the visit but you are often expected to owe a percentage of it (often 30-40%).   Visits are priced/coded based on time/complexity and issues addressed in session.  I file claims for in network patients.

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I am not able to check benefits to estimate costs for every patient.  If you are unsure or concerned about what you may owe using insurance, I encourage you to call your plan to ask specifically about benefits for OT (Occupational Therapy).

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If you are paying out of pocket (private pay by choice, or out of network), a 30% cash pay discount is applied.  After this discount, average initial evaluation costs are between $175-275 and follow-ups between $90-155, varying depending on time of session/complexity.

 

​Why should I see you if you are out of network with my insurance?

I think it’s important to say that not all therapy services are equal.  We all have different skills, experiences, and levels of expertise, and it is important to find the provider who can best meet your needs.  Don’t let insurance dictate your provider; you will find the fastest answer to your issue by going to a provider with the appropriate skill set.   I am unique in my combination of pediatric therapy + lactation expertise, with a skill set and scope that is wider than many other providers.  If I am not the right fit for you or your needs, I am honest about it and will not hesistate to collaborate or refer out to someone who may be better suited to get you the fastest resolution of your problem.

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My insurance is supposed to cover lactation; why don't you bill as a lactation consultant?​

For many reasons! 

1.) Lactation is only one subset of my scope of practice; my scope as an OT includes so much more. Billing under the umbrella of my primary scope, as an OT, allows me to seamlessly transition to addressing other issues involved in your baby's care, without creating billing complexities and headaches with insurance.  I am credentialed with BCBS as an OT, not an LC, but lactation fits under the larger scope of my OT practice under the umbrella of feeding treatment. One common example: if your baby has any type of torticollis or motor concern, this is within my scope to address, and having care for both feeding AND motor issues under the umbrella of OT services works well....we can move from a feeding focus to a motor focus easily, or address both simultaneously.

 

In lactation, we are able to feasibly bill for both mother and baby, since it's impossible to seperate the two...you work as a unit.  I just choose to approach it from the standpoint with baby as the primary focus.  Rest assured, I am well versed in and equipped to address "mom specific" issues that arise in lactation...these are just integrated into the "big picture" of feeding.

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2.) Insurance makes reimbursement for lactation is complicated.  Some companies will only reimburse services in the hospital setting; others do not credential lactation consultants on their panels at all, since "lactation consultant" is an unregulated term and not a licensed profession by itself.   There are a wide range of professionals working in the lactation space who have other backgrounds--nursing, physicians, therapists, each with their own scopes of practice, while there are other "stand alone" IBCLC's that do not have other degrees/licenses.   

 

Insurance is a mess, honestly....which is why most lactation consultants opt out entirely, it's a lot to navigate.  

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What's your cancellation policy?

I require 24 hours notice for cancellations; otherwise, it's a $25 fee for the missed appointment, or the full missed appointment fee for a second incident. I am a mom and a human and I understand that last minute illness/emergencies happen, and I absolutely extend grace where I can.  However, please understand that when you book a slot, this is a MINIMUM of an hour on my schedule.  Most evaluations require a 2 hour time block, and your fee covers my time to review your paperwork, see you in person face to face for 90+ minutes, write your treatment plan and evaluation, correspond with your medical team, etc.  It can amount to 2.5-3 hours of unpaid time in the event of a last minute cancel or no show...these are not short appointments.  Last minute cancels and no shows mean both lost time that I cannot offer to another client on the waiting list and lost income.  I require a card on file and have a late cancel/no show fee in place to protect my small business.

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I openly tell my patients that if things are going great, and they do not feel like that have questions or concerns that need a face to face appointment, that they can cancel.  I just ask for an early heads up so I can offer that slot to another person waiting.  

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