fees and Insurance information

Latched Louisville is in-network with the following insurance plans:

Anthem BCBS, Cigna, CareSource, Humana, Aetna, United, Medicaid, and Tricare.

We are not in network with Anthem plans with Prefix starting with VXZ, YRK and YRH

You will need to initiate a health insurance coverage check through our billing service, The Lactation Network if you have any of the following plans:
• Blue Cross Blue Shield PPO
• Anthem PPO
• United Healthcare PPO & HMO (Hawaii pending)
• VA CCN
• PNOA (logo on card)
• Multiplan (logo on card).
You can do that here: https://registration.mytln.care/?practiceId=0018V00002Nr2Zj

If you have Cigna health insurance, you can check your coverage here: https://portal.wildflowerhealth.net/affiliate-care...

The Lactation Network and Wildflower Health are middle men between us (Latched Louisville and you) and health insurance companies. With this arrangement, these companies assume all risk of denied claims, underpayments and wait times. They also have contracts with commercial insurance plans to cover your visit fully without any cost sharing (meaning if you are approved, you will not have any patient responsibility for cost such as a copay or deductible).

If you do not have the above plans, don't worry. If you have Medicaid or any other health insurance not listed above, we can still bill your health insurance ourselves.

There is a $1 appointment holding fee (unless you have Medicaid) for every appointment scheduled. It will be applied to your balance if one is due after insurance payment. If not, you will be reimbursed that $1. There is also a $50 no show fee or $25 late cancellation fee if the appointment is canceled less than 24 hours in advance.

Coverage of lactation services varies between insurance companies and your individual insurance plan.  Some plans may require some amount of patient responsibility, e.g. a copay, coinsurance, or may apply a deductible. We will bill your insurance company, and follow up with you by email with an invoice if your insurance determines any amount of “patient responsibility.” The card that you place on file at the time of your visit will be the card to which any invoices are applied. Invoices are sent to the email address provided when you submit your intake form. Invoices are automatically charged after 7 days of sending by email.

It is your responsibility to check coverage with your insurance company if you are concerned about coverage. We cannot tell you how much your insurance plan will pay for your visit before it happens. If you need to have this information before our visit, please contact your insurance company and give them the following information when asking for coverage details:

Provider: Tereza Peercy -or- Latched Louisville LLC

NPI: 1275003519

Typical E/M codes used for visits: 99205 (new patient), 99215 (existing patient)

Cost of services: self-pay

Lactation Evaluation (50 minutes): $150

Flange Fit (15 minutes): $40

cancellation/no-show fee

A $50 charge for same-day cancellation or no-show will be applied to the credit card on file.

faq

• My insurance plan says I get six lactation visits at no cost; why did you send me a bill?

  • Latched Louisville will bill your insurance company for a healthcare visit by a medical provider. We do not utilize typical lactation education or childbirth education codes that your plan may offer to you at no cost. These codes do not reimburse at a rate that is sustainable for our private practice.

• Why do you need my baby’s insurance information?

  • Latched Louisville will bill the mother’s and the baby’s insurance plan for each visit. Occasionally, the visit does not require an evaluation of the baby such as: weaning consults, flange fitting consults, exclusive pumping consults, or any consult in which the baby is not physically present for the visit. If we are examining your baby, weighing your baby, discussing your baby’s digestion, growth, sleep, etc.. then we will also document and bill for the baby. We do not send you an invoice for the baby. If there is a patient responsibility after the claim has been processed through your insurance, we settle the account and do not ask you to pay that portion. We only collect patient responsibility for the mother.

• Why do I need to have a credit card on file to book a visit?

  • Latched Louisville keeps your credit card on file to ensure we are paid for the services we render. We always send an invoice via text or email and allow 7 days for you to view and pay on your own. We will process the card on file if we have not received payment after 7 days of sending the initial invoice.

• What if my insurance doesn’t cover your lactation services?

  • We are in network with most all insurance carriers and bill our services as “Office or other outpatient visit for the evaluation and management of a patient which requires a medically appropriate history and/or examination and high medical decision making”. We are not billing for lactation services. We are billing as a medical visit and have not had any claims rejected due to uncovered services. There are times when a patient has a high deductible plan and has to meet that deductible before the insurance company will reimburse for services. This is the patient’s responsibility to understand before booking a visit with us.

• I got an EOB from my insurance company and it says I owe $395 for my visit. Why are you charging so much?

  • An EOB is not a bill. This is an explanation of benefits which describes which services were rendered and how much your insurance plan intends to pay for those services. We use e/m codes 99205 and 99215 for our visits which are typically 60 minutes in duration. This code is attached to a fee determined by various factors. Each insurance plan will have a different rate they are willing to pay for these codes. We accept whatever your particular plan has determined to pay for each code. Some plans pay as low as $60 for each visit and some pay as high as $170 for each visit.