Self-pay (out-of-network) clients:
I will provide you with a superbill suitable for you to submit to your insurance. The superbill (which will also serve as a payment receipt) will be coded appropriately to the level of service provided during the visit. You agree to pay me before or at the time of the visit (cash, check, credit card, or FSA).
Insurance (in-network) clients: Claims for my care will be submitted directly to Aetna, BlueCare, Amerigroup, or UHC Community Plan. Tennessee Lactation Care LLC will appeal all cost-sharing under the Affordable Care Act which states that lactation services are preventive and not subject to cost-sharing. If my insurance provider applies any portion to deductible or coinsurance and appeal attempts are unsuccessful, I will be invoiced for the remaining balance and I agree to pay within 7 days for all applied charges for all visits.
If one of us (me or my baby) is on different insurance and therefore out-of-network for Tennessee Lactation Care LLC, I agree to pay $200 per visit, $175 for follow up visits. I will receive a superbill for this amount and can submit for out-of-network insurance.
Tennessee Lactation Care LLC is providing care to me and to my baby or babies; together we are all the client of Tennessee Lactation Care LLC.
My initial visit includes 2 weeks of follow up support by secure messaging, email, or text.
If my location has a travel fee applied, I understand that this is not eligible for insurance reimbursement.
I am responsible to verify my own lactation benefits. Tennessee Lactation Care LLC can only see that I have benefits, they cannot see if I have any special circumstances that might prevent my insurance provider from covering services. If my plan denies coverage of lactation services after the claims have been submitted, I am responsible to pay at the self-pay rate. I understand I should refer to my plan benefits and call my insurance directly to verify lactation coverage.
Tennessee Lactation Care LLC may communicate with my insurance company in reference to the services provided to me and my baby or babies. Tennessee Lactation Care LLC may communicate with my credit card company or bank for any payment related matters. It is my responsibility to provide accurate and current payment and insurance information. I will update my credit card information as needed and am responsible for any costs and fees associated with my failure to provide updated information.
These policies apply to Tennessee Lactation Care LLC and its representatives.
Stripe: Payments may be made electronically using a credit card or fund transfer. I use Stripe to process payments. Stripe meets the high standards of HIPAA and the banking industry for security and privacy with regard to financial transactions. However, Stripe may send, automatically or per your request, email or text message receipts that reveal personal health information such as the date and type of lactation visit. If you are not comfortable with this, payment may be made via cash or check instead.
Cancellation policy: I understand that I am responsible for all charges associated with this visit. If I cancel with less than 24 hours notice, I will be invoiced a cancelation fee of $25. I will not be able to rebook a visit until this cancelation fee is paid.
This page states the Terms and Conditions under which you, the website visitor (hereinafter “you” or “visitor”), may use this site, the content of which is owned by or licensed to Tennessee Lactation Care LLC. By using this site, you agree to be bound by all of the Terms and Conditions set forth below. If you do not accept these Terms and Conditions, please do not use this site. Tennessee Lactation Care LLC may, at its sole discretion, revise these Terms and Conditions at any time; therefore, you should visit this page periodically to review the Terms and Conditions.
Tennessee Lactation Care LLC seeks to : support breastfeeding mothers and their babies on their breastfeeding journey.
Although Tennessee Lactation Care LLC strives for timeliness and accuracy in all of its materials, Tennessee Lactation Care LLC makes no representations, warranties, or assurances as to the availability, accuracy, currency, or completeness of this site or its contents. Tennessee Lactation Care LLC shall not be liable for any damages or injury resulting from your access to, inability to access, or use of this site, including, without limitation, any damages or injury arising from any links to other sites contained within or referred to in this site.
Tennessee Lactation Care LLC is committed to preserving your right to privacy. Tennessee Lactation Care LLC does not collect identifying information about you (such as your name, address, telephone number, or email address) unless you voluntarily submit that information to us through our Contact Us page, our newsletter subscription pages, or other means.
Please do not provide any confidential information (including health information) to us via electronic communication. Any information you do submit will not be sold to any third parties. If we publish any information you provide to us on the website, we will only disclose personally identifiable information agreed upon by you.
We use “cookies” on this site. A cookie is a piece of data stored on a site visitor’s hard drive to help us improve your access to our site and identify repeat visitors to our site. For instance, when we use a cookie to identify you, you would not have to log in a password more than once, thereby saving time while on our site. Cookies can also enable us to track and target the interests of our users to enhance the experience on our site. Usage of a cookie is in no way linked to any personally identifiable information on our site.
If you are concerned about the information You have provided to Tennessee Lactation Care LLC or would like to review, update, or delete that information, please contact us at email@example.com .
Tennessee Lactation Care LLC will make reasonable efforts to comply with your wishes.
Contact Us and “Ask an Expert”
The Contact Us page is the primary means of communication with Tennessee Lactation Care LLC for a website visitor. Website visitors may use the Contact Us page to send questions or content suggestions to us. Any health information submitted through the Contact Us pages is not stored in a way that is personally identifiable. We may, unless you indicate otherwise, store, edit, and excerpt your email for use in Q&As, presentations, analyses, and other similar purposes. In these cases, we will delete any content that would specifically identify you as the writer of the email.
The information provided through the Website is for educational purposes only and should not be considered medical advice. It is not meant to replace the advice of the physician who cares for you or your child. All medical advice and information should be considered to be incomplete without a physical exam, which is not possible without a visit to your doctor.
The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. Tennessee Lactation Care LLC makes no representation and assumes no responsibility for the accuracy of information contained on or available through this website, and such information is subject to change without notice. All information provided on the website is general information provided for educational purposes. You are encouraged to confirm any information obtained from or through this website with other sources, and review all information regarding any medical condition or treatment with your child’s physician. Never disregard professional medical advice or delay medical treatment because of something you have read on this website.
The only personally identifiable information that is actively collected by Tennessee Lactation Care LLC is email addresses of individuals who opt-in to our newsletter programs. These email addresses are only used for delivering our newsletters. Users may remove their email address from our list by using the unsubscribe link provided at the bottom of each newsletter.
Tennessee Lactation Care LLC welcomes your comments on its site and content. However, you acknowledge that if you send us suggestions, ideas, notes, drawings, concepts, photographs, or other information (collectively, the “Information”), the Information shall be deemed, and shall remain, the property of Tennessee Lactation Care LLC. By submission of any Information to us, you assign to us and we shall exclusively own all now known or hereafter existing rights to such Information and shall be entitled to unrestricted use of the Information for any purpose whatsoever, commercial or otherwise, without compensation to you.
As a user of this site, you are responsible for your own communications and are responsible for the consequences of their posting. Therefore, do not do any of the following: transmit to us material that is copyrighted, unless you are the copyright owner or have the permission of the copyright owner to post it; send material that reveals trade secrets, unless you own them or have the permission of the owner; send material that infringes on any other intellectual property rights of others or on the privacy or publicity rights of others; send material that is obscene, defamatory, threatening, harassing, abusive, hateful, or embarrassing to another user or any other person or entity; send sexually explicit images; send advertisements or solicitations of business; send chain letters or pyramid schemes; or impersonate another person.
Tennessee Lactation Care LLC reserves the right to expel users and prevent their further access to this site for violating these terms or the law and reserves the right to remove any communications from this site. The violation of any of the terms and conditions set forth on this Terms and Conditions page shall result in the immediate revocation of your right to use the content and obligates you to immediately destroy any copies of the content in your possession.
This site contains links to websites owned by third parties. These links are provided solely as a convenience to you and are not an endorsement by Tennessee Lactation Care LLC of the contents of those other sites. Tennessee Lactation Care LLC is not responsible for the content of any linked sites and makes no representations regarding the content or accuracy of materials on such sites. If you decide to visit any third-party sites using links from this site, you do so at your own risk.
Tennessee Lactation Care LLC does not recommend, endorse, or make any representation about the efficacy, appropriateness, or suitability of any specific tests, products, procedures, treatments, services, opinions, health care providers, or other information that may be contained on or available through this website. Tennessee Lactation Care LLC is not responsible nor liable for any advice, diagnosis, treatment, or any other information, services, or products that you obtain through this website.
Disclaimer of Warranties
Tennessee Lactation Care LLC does not warrant that the site will operate error-free or that the site or its server are free of computer viruses or other harmful material. If your use of the site or the site’s material results in the need for servicing or replacing of equipment or data, Tennessee Lactation Care LLC shall not be responsible for those costs. This site and its material are provided on an “as is” basis without any warranties of any kind. Tennessee Lactation Care LLC, to the fullest extent permitted by law, disclaims all warranties, including the warranty of merchantability, non-infringement of third parties’ rights, and the warranty of fitness for a particular purpose.
Disclaimer of Consequential Damages
In no event shall Tennessee Lactation Care LLC, its medical consultants, or any third parties mentioned in the site content be liable for any damages whatsoever (including, without limitation, incidental, consequential, or punitive damages, lost profits, or damages resulting from lost data or business interruption) resulting from the use or inability to use material on this website or sites linked to this website whether based on warranty, contract, tort, or any other legal theory, and whether Tennessee Lactation Care LLC is advised of the possibility of such damages.
Use of Site Material
The contents of this site, including, without limitation, text, graphics, images, and other content (the “Content”) are owned by or licensed to Tennessee Lactation Care LLC and are protected by copyright under both United States and foreign laws. Unauthorized use of the Content violates copyright, trademark, and other laws. You agree to retain all copyright and other proprietary notices contained in the original Content on any copy you make of such material. You may not sell or modify our Content or reproduce, display, distribute, or otherwise use the Content in any way for any public or commercial purpose. Use of the Content on any other website or in a networked environment is prohibited.
This site originates from within the United States. Tennessee Lactation Care LLC does not claim that the Content on this site is appropriate or may be used outside of the United States. Access to the Content may not be legal by certain persons or in certain countries. If you access the site from outside the United States, you do so at your own risk and are responsible for compliance with the laws of your jurisdiction.
These Terms and Conditions are governed by the substantive laws of the State of Tennessee, without respect to its conflict of laws principles. You agree to submit to the jurisdiction of the courts situated in the State of Tennessee with respect to any dispute, disagreement, or cause of action related to or involving this site. If any provision is found to be invalid by any court having competent jurisdiction, the invalidity of such provision shall not affect the validity of the remaining provisions of these Terms and Conditions, which shall remain in full force and effect. No waiver of any of these Terms and Conditions shall be deemed a further or continuing waiver of such term or any other term. Except as expressly provided elsewhere in this site, these Terms and Conditions constitute the entire agreement between you and Tennessee Lactation Care LLC with respect to your use of this site.
HIPPA for Tennessee Lactation Care LLC
Tennesseelactationcare.com firstname.lastname@example.org 901-568-9202
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.
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
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
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.
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.
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 have to 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
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.
- 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.
- Effective Date of this Notice: January 20, 2020
- Privacy Officer: Angela Plunkett RN, BSN, IBCLC email@example.com
- We never market or sell personal information.