In Network with Aetna
Aetna has implemented significant changes to their lactation coverage. I aim to provide transparent and educational information to help you understand how Aetna processes claims for lactation services.
Key Concepts to Understand:
My Services:
I provide breastfeeding and lactation services in my Montclair, New Jersey office and limited home visits. While most Aetna plans cover my services, it's crucial to verify your specific coverage.
Booking and Billing Process:
Aetna has implemented significant changes to their lactation coverage. I aim to provide transparent and educational information to help you understand how Aetna processes claims for lactation services.
Key Concepts to Understand:
- Coverage now limited to 6 total billing codes per year (not 6 full consultations)
- Each consultation typically uses 2 codes (one for parent, one for baby)
- Effectively limits coverage to 3 consultations per year
- "Free" online classes or services through pump suppliers count against the 6 code limit
- Child's portion of the consult no longer covered as preventive care
- Potential out-of-pocket costs, even with 100% coverage stated by Aetna
- "Patient Responsibility" amounts determined by Aetna will be charged
My Services:
I provide breastfeeding and lactation services in my Montclair, New Jersey office and limited home visits. While most Aetna plans cover my services, it's crucial to verify your specific coverage.
Booking and Billing Process:
- Check your Aetna plan benefits before booking
- Provide credit card information during booking
- I submit claims and perform up to 2 rounds of appeals if necessary
- Any remaining balance will be charged to your card on file
- I encourage you to contact Aetna if coverage issues arise
- Reimbursements will be made if insurance later covers the visit
- Your insurance plan is a contract between you and Aetna
- Contact Aetna directly for specific coverage details
- Be aware of potential out-of-pocket costs (deductibles, coinsurance, copayments)
- "Covered" does not always mean "paid in full"