Insurance and Payments

In-Network Insurance

Sally Wood Lactation is in-network with the insurance payors listed below. There will be no fee required when booking for in-network clients. We will file for reimbursement with your insurance plan, although this is not a guarantee that the consultation will be covered in its entirety. it is your responsibility to be knowledgeable of your benefits. We ask that you contact your insurance plan prior to your visit with us and follow-up with your insurance plan in the event of any dispute or issues regarding amounts due by you. We are considered in-network for most, but not all plans, with the following payors:

Aetna

Cigna

Coventry

GEHA

Meritain

Tricare (Prime and Select)

United

UMR

VA CCN

Out-of-Network Insurance

If you have not determined in-network coverage for your consultation, you will be billed for the consultation at the time of the appointment. Your insurance company may, and should, still cover the cost. It is suggested that you contact your insurance company prior to booking to obtain prior authorization. While many companies do cover lactation care, we cannot guarantee our services will be covered by your insurance carrier.

Upon request, you will be given a Superbill to submit to your insurance company for reimbursement.

Your insurance policy is a contract between you and the insurance company. While every effort is made to utilize your benefits, the terms of your plan will prevail and the fees for services rendered are your responsibility.

Self-Pay Patients

If you do not have insurance or have insurance that we cannot bill directly, you will be offered a prompt-pay discount and payment is expected in full at the time of service.

Prompt Pay Discounts

Sally Wood Lactation offers discounted self-pay rates for families who have insurance that we are not in-network with or for those who are not covered by an insurance plan. The rates reflect the cost of the usual and customary services provided. Call for information on the rates for the particular service that you need.

Additional Fees

INFANT CONSULTATION FEE: If infant is not covered under mother's insurance plan, a $50 fee will be charged for infant.

TWINS: A fee of $50 will be applied to out-of-network lactation consultations with twins.

TRAVEL FEE: A travel fee of $50 will be applied to lactation consultations outside of regular service area. Our regular service area includes Augusta, Martinez, Evans, Harlem, Appling, Hephzibah and North Augusta.

TRICARE FAMILIES: Tricare does not reimburse for in-home consultations, therefore a $50 Home Visit Fee will be charged for in-home consultations. There is no additional fee for an office consultation.

Payment Policy

Payment will be charged at the time of service. We accept cash and credit cards including American Express, MasterCard, Visa and Discover.

HSA/FSA cards are also accepted.

Missed Appointment Policy

If a consultation is cancelled within 24 hours of the appointment, you will be charged a $50 fee. Cancelling more than 24 hours before the appointment time will not incur a fee. If you are not able to keep your appointment due to an emergency or illness, please call us at 706-504-2227

Contacting Your Insurance Company - FAQs

What should I ask when I call my insurance company?

“Can I have your name, agent ID and a ticket number for this call?”
“Is my insurance plan subject to the Patient Protection and Affordable Care Act?”
“If my insurance plan is not subject to the Patient Protection and Affordable Care Act, can you tell me why that is?”
“Where/how can I get the lactation services I am entitled to under section 1001 of the Patient Protection and Affordable Care Act which entitles me to certain preventive services with no cost sharing such as comprehensive lactation support and counseling?”

What information should I have available when I call my insurance company?

Your policy information including member ID and group ID
Name of practice/provider: Sally Wood Lactation (Reliability Excellence Medical and More, LLC)
Sally Wood Lactation’s Tax ID#: 45-3868616
Sally Wood Lactation’s Group NPI#: 1669182762

Sally Wood, RN, IBCLC Individual NPI#: 1457757056

Semone Williams, IBCLC Individual NPI#: 1154061778

Service location type: 11 for office visits; 12 for home visits
Diagnosis codes typically used for BABIES: P92.5, P92.9, Z76.2
CPT codes typically used for BABIES: 99401-99404, S9443
Diagnosis codes typically used for MOTHERS: Z39.1
CPT codes typically used for MOTHERS: 99404, S9443, 99344, 99349, 98960

Does Sally Wood Lactation engage in balance billing?
No. “Balance billing” is asking the patient to pay the difference between our normal fee and the insurance company’s normal payment. That’s a breach of our managed care contracts. What we charge to the patient’s credit card is the portion the insurance company has determined is not covered by the company (co-insurance).

Credit Card on File Policy

Sally Wood Lactation requires that a valid credit card be kept on file. The policy is designed to:

Help avoid all billing related fees
Streamline the billing process in our office and eliminate the expenses related to handling overdue accounts
Allow us to focus our time and energy on you and your baby’s care.

How the policy works:

At the time of scheduling, you will be asked for your credit card information to be electronically stored in encrypted form in our billing system. Only the last four digits are visible to our staff.
Your signature will authorize the card to be used for all charges not covered by your insurance, including co-pays, deductibles, co-insurance, patient responsibilities, services not covered by insurance and cancellation fees.
If applicable, we will bill your insurance carrier as a courtesy for all charges related to the visit. When we receive an explanation of benefits (EOB) from your insurance and a co-insurance amount has been determined, we will send you an invoice. You may review the charges, call your insurance company to ask questions, or call our office to use a different form of payment. In the event the invoice is not paid within 30 days, the credit card on file will be charged.

Please remember that this policy does not restrict your right to appeal any charge made to your credit card. Should you feel that we have charged your card in error, you may contact our office ASAP. If a mistake has been made, we will reverse the charges.

Credit Card On File FAQs

When do I have to pay for services?

If we are in-network with your insurance company, you will not be charged for any service unless the EOB shows that a co-insurance amount is owed. If you do not have insurance or your insurance plan is out-of-network, you will be charged for services at the time of the appointment.

Why am I being singled out? I always pay all my bills.

All patients are required to keep a credit or debit card on file. This policy isn’t personal; we apply it equally to all of our patients.

What about identity theft and privacy?

Under HIPAA, we are under strict rules and guidelines in terms of protecting patient privacy and the credit card is considered protected health information. Because of HIPAA rules, our office is far more secure than most retail establishments as it relates to identity theft. We use a secure gateway that is completely compliant as required by law. The staff has no access to your actual credit card number once stored in the gateway.

I don’t have a credit card.

You are welcome to leave a debit card, HSA (Health Savings Account) or FSA card on file or pay with cash or check for the visit in full. We understand there are legitimate reasons you might not have a card. If this is the case, we will work out a payment plan with you.

Isn’t this the same as “signing a blank check”?

You will always be informed and offered an opportunity to make alternative arrangements before your card is charged. What we are doing is similar to what hotels or rental car companies do at each check-in. Additionally, all credit card contracts give cardholders the right to challenge any charge against their account.