Intake Forms

Billing, Payments, & Insurance

 BREAST4 Babes, Inc. offers several payment options to meet all our customers' needs. We accept all major Debit and Credit Card payments via PayPal or Square, HSA (Health Savings Account), or FSA (Flex Spending Account); we provide a superbill for Reimbursement to be submitted to your insurance. 

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Payments are due at the time of booking services or before the service is rendered. This is considered your retainer to ensure care on the scheduled date and time agreed upon. All payments are non-refundable. Appointments can be rescheduled, and payments for classes will be used for a future class or service of your choice. An invoice will be sent to you via email via Paypal/ Square. Once paid, your appointment will be secured.

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If your health insurance plan is one of the few that isn't required to cover breastfeeding support and counseling, or you're not interested in submitting for reimbursement, you should be aware that home visits from an IBCLC are eligible for Health Savings Account (HSA) expenses.  If you have an HSA through your work or your insurance company, you can use your superbill to submit for reimbursement from your HSA funds- you may even be able to use your HSA debit card to pay for the visit.

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Non-refundable deposit retainer (home visits): $75.00 *COVID-19 precautions per CDC, 10 mile radius from downtown Cincinnati 

Non-refundable deposit retainer (virtual visit): $50.00

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Financial Assistance Programs/ Easy Payment Program

With Flex/ Easy Payment, you can now receive BREAST4 Babes, Inc. services and pay biweekly installments at no extra charge with your major credit card. The service price, fee, deposit, and applicable sales tax will be divided according to the specified number of payments. During your intake process, choose the Easy Pay option when available*. The first Easy Pay installment will be billed on the date or service. Then, approximately every 14 to 15 days, each remaining installment will be billed to the credit card used on the original date of service. 

 

Flex/ Easy Pay billing dates are set according to the date of service; billing dates for future installments can't be customized or changed. Flex/ Easy Pay offers are subject to approval by BREAST4 Babes, Inc. based on the number of service items, price, and payment history. Please note: certain payment methods, including prepaid cards, may not be available for items purchased with Flex/ Easy Pay. Missed payments or insufficient funds are subject to service charges:

 

Late Payment                          $25.00

Nonsufficient funds                $35.00

 

Two consecutive late payments/ missed payments will result in immediate payment of the full balance and all applicable charges or fees. Balances not paid in full by the end of the agreement are subject to a lawsuit, court costs, plus all applicable charges and fees.

 

Late payment fee:

A late payment fee (a late charge) is charged to a borrower who misses paying at least their minimum payment by the payment deadline.

 Income-based Fee Program

This program is designed to provide reduced or discounted care to those who have no means or limited means to pay for their medical services (Uninsured or Underinsured). In addition to quality healthcare, patients are entitled to financial counseling by someone who can understand and offer possible solutions for those who cannot pay in full. The Patient Account Representative’s role is that of a patient advocate, that is, who works with the patient and/or guarantor to find reasonable payment alternatives.

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 BREAST4 Babes, Inc. offers a Sliding Fee Discount Program to all who are unable to pay for their services. BREAST4 Babes, Inc. will base program eligibility on a person’s ability to pay. They will not discriminate on the basis of age, gender, race, sexual orientation, creed, religion, disability, or national origin. The Federal Poverty Guidelines are used to create and annually update the sliding fee schedule (SFS) to determine eligibility.  

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It is the policy of BREAST4 Babes, Inc. to provide essential services regardless of the patient’s ability to pay. Discounts are offered based on family size and annual income. Office visit discounts are made once an application is completed and returned to the front desk to determine if you or members of your family are eligible for a discount.

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The discount will apply to all services received at this clinic but not those services or equipment that are purchased from outside. This eligibility form must be completed every 12 months or if your financial situation changes.

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