Insurance and Billing

Understanding Your Coverage

At Arizona Breastfeeding Medicine and Wellness, we want to ensure you have a clear understanding of your insurance coverage. Please take a moment to review your insurance plan’s details, including deductibles, copays, and out-of-pocket maximums.

Contact Your Insurance Provider

To confirm your specific benefits and costs for an office visit with lactation services, reach out to your insurance company directly. We’re always happy to assist you, but your insurance provider can give you the most accurate information.  Our office can give you specific codes that we use to verify with your carrier. 

Our Billing Process

Insurance Claims: We will file your insurance claims on your behalf. However, please remember that insurance coverage can change, so it’s best to verify your benefits regularly.

Estimates: Any insurance estimates we provide are based on the information available at the time and may not be the final cost. **If we are unable to verify your benefits or coverage, we will charge a deposit until your insurance has a chance to properly process your claim(s). Please note that some insurance companies do not cover all of cost of your appointment(s); since we are an office-based provider we bill appointments as office visits + lactation (for your breastfeeding consultation based appointments).

Multiple Insurance Plans: If you have multiple insurance plans, please provide us with information on both and indicate your primary plan.

Out-of-Network Costs: If your insurance processes your claim as out-of-network, you may be responsible for additional costs.

Explanation of Benefits (EOBs): Regularly review your EOBs to understand how your claims were processed and any amounts due.

Invoices: If you receive an invoice, it means your claim has been processed and a balance is due.

Refunds: If your insurance requests a refund, you’ll be responsible for the amount owed.

Self-Pay: If you choose not to use insurance, you’ll be responsible for the full self-pay amount at the time of service.

Multiple Visits: We may bill separately for mother and baby, especially for lactation-related issues.

Office Visit Fees: You may incur a copay for office visits, even if they are related to lactation.

Procedure Fees: For procedures like tongue or lip-tie revisions, additional fees may apply.


Payment Options

We accept cash or credit card payments. If you have insurance, we’ll bill your provider directly. Co-pays are due at the time of service. 

Ultimately, your insurance coverage is unique to you. Please don’t hesitate to contact your insurance company for the most accurate information. We are excited to walk into this partnership with you, and warmly welcome you into our clinic.

Thank you,

Dr. Cara Riek, FNP-BC & Team

Insurance Plans Accepted

We are in-network with many plans, and we try to list all of them the best we can to help you understand ahead of time if we can run your insurance for your visit(s).

*If your insurance plan and/or card specifies that you will need a referral (from your PCP or other), you will need to provide us with a referral or we will not be able to accept your insurance. It is your responsibility to provide the referral from the necessary provider to our office.

*If you are in a AHCCCS or Community Health type plan, please call our office and we would be happy to work with you on an amount that works for you and us to help you out.

*For Honor Health (Ameriben) plans for Group HHH001, please note that this is an out-of-network plan for our clinic.

*For BCBS (HealthChoice) plans for Member IDs that start with “IAZ”, please note that this is an out-of-network plan for our clinic.

Contracted (in-network) plans below, click on your carrier and see which plans we participate in:

Aetna Affordable Health Choices® limited benefits insurance plan (SRC only)

Aetna Select℠

Aetna Voluntary Plans

HMO

Managed Choice® POS

Open Choice® PPO

QPOS®

Aetna Choice® POS II (Open Access)

Aetna Health Network Only℠ (Open Access)

Aetna Health Network Option℠ (Open Access)

Aetna Select℠ (Open Access)

Elect Choice® EPO (Open Access)

Managed Choice® POS (Open Access)

Aetna Choice® POS (Aetna HealthFund®)

Aetna Choice® POS II (Aetna HealthFund®)

Aetna HealthFund® Aetna Health Network Only℠ (Open Access) 2/10/2022

Aetna HealthFund® Aetna Health Network Option℠ (Open Access)

Aetna Open Access® Elect Choice® EPO (Aetna HealthFund®)

Aetna Open Access® Managed Choice® POS (Aetna HealthFund®)

Open Access Aetna Select℠ (Aetna HealthFund®)

Open Choice® PPO (Aetna HealthFund® (AZ) Summit Healthcare

2022 Arizona HealthNetworkOption Open Accesss (For Qualified Conversion Plan Member Only)

Aetna Premier Care Network (APCN) - Choice POS II/Open Access Managed Choice

Aetna Premier Care Network (APCN) - Open Access Aetna Select

Aetna Premier Care Network (APCN) - Choice POS II/Open Access Managed Choice

Aetna Premier Care Network (APCN) - Open Access Aetna Select

Aetna Premier Care Network Plus (APCN Plus) - Banner Network - Choice POSII

Aetna Premier Care Network Plus (APCN Plus) - Banner Network - Open Access Aetna Select

Aetna Premier Care Network Plus (APCN Plus) - Choice POS II/Open Access Managed Choice

Aetna Premier Care Network Plus (APCN Plus) - Open Access Aetna Select

Aetna Premier Care Network Plus (APCN Plus) - Banner Network - Choice POSII

Aetna Premier Care Network Plus (APCN Plus) - Banner Network - Open Access Aetna Select

Aetna Premier Care Network Plus (APCN Plus) - Open Access

Aetna Select

Arizona Banner HMO

Arizona Banner Open Access Managed Plus

Arizona Banner PPO

Arizona HealthNetworkOption (HNOption)

Arizona HMO

Arizona Open Choice PPO

Arizona Summit

Aetna with Innovation Health Aetna Select

Aetna with Innovation Health POS

Aetna with Innovation Health PPO

Aetna Select Open Access / Aetna Select

Banner Choice POS II Multi Tier

Banner Elect Choice Open Access/Elect Choice

Banner HMO

Banner Managed Choice / Choice POS II

Banner Open Access Aetna Select

Choice POS II

Elect Choice Open Access/Elect Choice

HMO / Health Network Only

Managed Choice Open Access/Managed Choice

PPO

National Advantage™ Program

Banner – Aetna: Arizona HMO Bronze, Sliver & Gold Plans

Banner | Aetna: Arizona

Medical Networks

National PPO/EPO

CHS Arizona PPO (No access outside of Arizona)

BluePreferred Care Tiers (Triple Choice Plan for State of AZ Employees)

Indemnity

BlueHPN National EPO (In AZ: Alliance Network)

Alliance PPO/EPO

Alliance HMO

MaricopaFocus

*Please note that most out of state plans (i.e.: BCBS of CA, BCBS of IL, etc... to include Anthem BCBS) may not cover your office visits in our clinic, and will commonly apply the amount due based on your plan's deductible and therefore there we will collect a deposit at time of service, submit these claims on your behalf, and refund up to the amount of deposit in the event that your plan reimburses our office for the visit.
Tricare Select

Tricare Prime

*Please note ChampVA may be out-of-network, but we will bill them.

*Triwest will be in-network in early 2025
Select EPO

UHC NexusACO NR

UHC NexusACO NRP

Choice HMO/ Choice +HMO

Choice EPO

UHC Charter EPO

Nat Ancill All Other

UHC NexusACO RP

UHC NexusACO RB

UHC NexusACO NRB

UHC Charter HMO

UHC Charter POS

UHC Core Choice Plus POS

Select HMO/ Select +

UHC NexusACO R

UHC NexusACO OAP

Choice Plus POS

UHC NexusACO OAP

UHC NexusACO OA

PPO

UHC Core EPO

UHC Core HMO

Select Plus POS



*UMR does NOT cover the cost for tongue/lip tie procedures

*AZONEX is considered an out-of-network plan, per UnitedHealthcare

*OptumRX is considered an out-of-network plan, per UnitedHealthcare

CIGNA HealthCare of Arizona, Inc. - Phoenix IPA

Cigna Preferred Partner HMO (formerly Cigna Medical Group)

Open Access Plus, OA Plus

ChoiceFund OA Plus with CareLink

Open Access Plus

OA Plus

ChoiceFund OA Plus

PPO

Choice Fund PPO