We are In-Network Providers

For most of our visits insurance for both baby and mother/ lactating parent are billed.   
    We accept most major insurance including Medicaid plans and Washington Apple Health. Please contact your insurer for specific details on the benefits of your individual plan and for the In-Network status of our clinic and providers. You are responsible to know your insurance coverage and benefits before your scheduled visit. Use of insurance does not guarantee full coverage of services. If your individual plan has a deductible that has not yet been met, copays or coinsurance required for services you will receive a bill for those amounts due. For a list of our fees and common billing codes we use, scroll to the bottom of this page or click here. Have more questions? Contact our Billing Specialist directly at (425) 315-5178.

You are financially responsible for payment of services provided by Pacific Wellness and Lactation. Additionally, if you are seeking lactation or breastfeeding support, insurance for both baby and mother/ lactating parent are billed. If you have a question about how your insurance company will process charges for a service or procedure, please contact your insurer directly or review your benefits handbook.

Definitions of common terms used by insurance:

Adjustment - The portion of your bill that your clinic, hospital, doctor or healthcare provider has agreed not to charge. Insurance companies pay hospital and clinic charges at discounted rate. The amount of the discount is specific to each insurance company. This means your healthcare provider, by being In-Network, agrees to accept a discounted rate from the insurer for the service provided to you and will not send you a bill for the entire amount billed for the services. This does not mean you will not receive a bill from the healthcare provider. If you have a deductible or coinsurance in your contract with your insurer your healthcare provider is responsible/ required to collect those amounts.

Deductible - The amount your insurance requires you to pay for your healthcare services before your health insurer pays. Deductibles are based on your benefit period (typically a year at a time). Example: If your plan has a $2,000 annual deductible, you will be expected to pay the first $2,000 toward your healthcare services. After you reach $2,000, your health insurer will cover the rest of the costs unless you have agreed to coinsurance, then the insurer will only cover the agreed upon percentage of health care costs as listed in your contract.

Coinsurance - A certain percent you must pay each benefit period after you have paid your deductible. This payment is for covered services only. You may still have to pay a copay. Example: Your plan might cover 80 percent of your medical bill. You will have to pay the other 20 percent. The 20 percent is the coinsurance.

Allowed Amount - The highest amount your insurer will cover (pay) for a service and the most you can be billed by an In Network provider.

Benefit Period - When services are covered under your plan. It also defines the time when benefit maximums, deductibles and coinsurance limits build up. It has a start and end date. It is often one calendar year for health insurance plans.
Example: You may have a plan with a benefit period of January 1 through December 31 that covers 6 preventive care visits. The 7th or more session will not be covered.
 

Coinsurance Limit (or Maximum) - The most you will pay in coinsurance costs during a benefit period.

Contract - The agreement between an insurance company and the policyholder.

Copayment (Copay) - The amount your insurance requires you to you pay to a healthcare provider at the time you receive services. You may have to pay a copay for each covered visit to your doctor, depending on your plan. Not all plans have a copay.

Covered Charges - Charges for covered services that your health plan paid for. There may be a limit on covered charges if you receive services from providers outside your plan's network of providers.

Covered Service - A healthcare provider’s service or medical supplies covered by your health plan. Benefits (payment) will be given for these services based on your plan.

Dependent Coverage - Coverage for your dependents who qualify.

Our Fees:

    Below are the fees we bill out to your insurer. As In-Network providers for most local insurers and Medicaid, these are highly discounted when using your insurance and there may be no out of pocket cost to you. If you have a deductible that needs to be met, copays or co-insurance then you will receive a bill from our office with those amounts. For the exact discounted rate and to know what you might be responsible for, please call your insurer directly.

When we are working with both an infant and mother/ lactating parent we complete a full office visit for both infant and parent and bill accordingly. We are a medical clinic and will bill insurance on behalf of the infant and mother/lactating parent.  Please note two claims will be submitted and both claims will be subject to deductible, coinsurance and copay. Our billing is based on time and complexity of your visit. We offer discounts and payment plans for uninsured, underinsured and cash paying clients. Please call our office for details. Have more questions? Contact our Billing Specialist directly at (425) 315-5178.

New Patient Office Visit:

99205 - 280.00

99204 - 240.00

99203 - 200.00

99202 - 160.00

Follow Up Patient Office Visit:

99215 - 190.00

99214 - 170.00

99213 - 150.00

99212 - 130.00

99211 - 90.00

Frenectomy Procedure:

41115 Lingual Frenectomy (tongue tie release) - 400.00

40819 Labial/ Maxillary Frenectomy (lip tie release) - 500.00

Common ICD 10 Diagnosis Codes Used:

Ankyloglossia (tongue tie) - Q38.1

Lip Disorder (lip tie) - K13.0

Difficulty Feeding - P92.5

Example of a typical claim* submitted to insurance for lactation support and tongue tie evaluation and treatment (All done in a typical 1 hour to 1.5 hour office visit):

Pacific Wellness & Lactation NPI: 1518407758

Infant evaluation: 99203

Infant tongue tie release (frenectomy): 41115

Mother/Lactating Parent evaluation and lactation support: 99205

Follow up infant: 99213

Follow up lactation support for Lactating Parent/Mother: 99211+S9443

*this is an example and not a guarantee of what will be billed out or submitted. All claims/bills submitted to your insurer are based on complexity and time.

Have more questions? Contact our Billing Specialist directly at (425) 315-5178