Payment Policy and HIPAA

Payment Policy

THE LACTATION NETWORK (TLN):

If we have set up our consultation through The Lactation Network that means they have accepted your insurance and all insurance/billing will go through The Lactation Network. No payment will be required directly to me at the end of our consultation. TLN covers up to 6 lactation consultations.  I understand that Melissa is only in contract with Lactation Network and does not handle any payments/ insurance claims related to our consult. Any and all questions regarding insurance/payment will need to be direct to TLN, you can call them at (888) 510-0059 

AETNA: 

You will provide your insurance information when you fill out my in-take forms. Aetna typically covers up to 6 lactation visits. It is your responsibility to check with Aetna to verify your plan is covered for lactation services, this would include any telehealth visits. Even though Aetna may tell you are covered 100 percent, some AETNA plans do charge cost-sharing or a co-pay which will be charged to the credit card you put on file during booking. I work with a Biller who resubmits any claims that come back denied or charges co-pay or cost-sharing to avoid needing to charge anything to you, but on the very rare occasion after everything has been exhausted, I will need to charge. If their is a laps in coverage the full consult fee will be charged.  

SELF PAYMENT:

Payment is due to Melissa Schiff at the end of our consultation.

Initial consultations:

  • $190 In-Office / $150 Virtual

Prenatal consultations: 

  • $190 In-Office

Follow-up consultations: 

  • $175 In-Office / $85 Virtual

I can take cash, check, credit card and most HSA/FSA cards (Note: I will run the HSA/FSA card through my Square Reader, if it’s declined then another form of payment will be required).

Currently, I am not in-network with any health insurance companies other than AETNA. I am considered an out-of-network provider. I have a professional receipt called a Super Bill (a receipt with medical insurance coding) that I will provide you. I highly recommend submitting to your insurance. There is no guarantee that your insurance company will pay, but many families I serve do get reimbursed. Please note: it is your responsibility to submit the receipt to your insurance.

CANCELATION POLICY: 
I understand that there is a 24hr cancellation policy. I will cancel or reschedule my appointment before 24hrs of my booked appointment or I will be charged a $50 cancellation fee. A credit card is required to be on file at booking. 

NOTICE OF PRIVACY PRACTICES (HIPAA)

Your Information. Your Rights. Our Responsibilities.

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

  • Effective Date of this Notice 01-01-2022

  • Makana Breastfeeding INC. | Melissa Schiff, IBCLC | melissa@makanabreastfeedig.com | 773-575-2629

  • We will never market or sell your personal information.

  • Melissa Schiff, IBCLC is in contract with The Lactation Network through Ashland Health, LLC. If you are consulting with me through The Lactation Network, you will provide your insurance and personal information to The Lactation Network and I will provide my consult notes/care plan to The Lactation Network for them to submit the claim to your insurance company. This notice applies to The Lactation Network through Ashland Health, LLC serving the Greater Chicagoland Area.

  • Melissa Schiff, IBCLC is in-network with AETNA If you are consulting with me you will provide your insurance and personal information for AETNA in order for me to submit the claim.

Your Rights

You have the right to:

  • Get a copy of your paper or electronic medical record

  • Correct your paper or electronic medical record

  • Request confidential communication

  • Ask us to limit the information we share

  • Get a list of those with whom we’ve shared your information

  • Get a copy of this privacy notice

  • Choose someone to act for you

  • File a complaint if you believe your privacy rights have been violated

Your Choices

You have some choices in the way that we use and share information as we:

  • Tell family and friends about your condition

  • Provide disaster relief

  • Include you in a hospital directory

  • Provide mental health care

  • Market our services and sell your information

  • Raise funds

Our Uses and Disclosures

We may use and share your information as we:

  • Treat you

  • Run our organization

  • Bill for your services

  • Help with public health and safety issues

  • Do research

  • Comply with the law

  • Respond to organ and tissue donation requests

  • Work with a medical examiner or funeral director

  • Address workers’ compensation, law enforcement, and other government requests

  • Respond to lawsuits and legal actions

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your medical record

  • You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.

  • We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your medical record

  • You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.

  • We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications

  • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.

  • We will say “yes” to all reasonable requests.

Ask us to limit what we use or share

  • You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.

  • If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Get a list of those with whom we’ve shared information

  • You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.

  • We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

  • You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

  • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.

  • We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated

  • You can complain if you feel we have violated your rights by contacting us using the information on page 1.

  • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.

We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

  • Share information with your family, close friends, or others involved in your care

  • Share information in a disaster relief situation

  • Include your information in a hospital directory

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases we never share your information unless you give us written permission:

  • Marketing purposes

  • Sale of your information

  • Most sharing of psychotherapy notes

In the case of fundraising:

We may contact you for fundraising efforts, but you can tell us not to contact you again.

Our Uses and Disclosures

How do we typically use or share your health information?

We typically use or share your health information in the following ways.

Treat you

We can use your health information and share it with other professionals who are treating you.

Example: A doctor treating you for an injury asks another doctor about your overall health condition.

Run our organization

We can use and share your health information to run our practice, improve your care, and contact you when necessary.

Example: We use health information about you to manage your treatment and services.

Bill for your services

We can use and share your health information to bill and get payment from health plans or other entities.

Example: We give information about you to your health insurance plan, so it will pay for your services.

How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We must meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Help with public health and safety issues

We can share health information about you for certain situations such as:

  • Preventing disease

  • Helping with product recalls

  • Reporting adverse reactions to medications

  • Reporting suspected abuse, neglect, or domestic violence

  • Preventing or reducing a serious threat to anyone’s health or safety

Do research

We can use or share your information for health research.

Comply with the law

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

Respond to organ and tissue donation requests

We can share health information about you with organ procurement organizations.

Work with a medical examiner or funeral director

We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests

We can use or share health information about you:

  • For workers’ compensation claims

  • For law enforcement purposes or with a law enforcement official

  • With health oversight agencies for activities authorized by law

  • For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions

We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Our Responsibilities

  • We are required by law to maintain the privacy and security of your protected health information.

  • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

  • We must follow the duties and privacy practices described in this notice and give you a copy of it.

  • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.