(may include other companies that have "AETNA" printed on the card)
I have an existing contract with Aetna and will submit claims directly to them after each visit to be processed based on time and services provided. To verify, my name (Nancy Tsen) should appear in your provider directory as "In-Network".
Aetna will typically cover 100% up to a certain limit of procedure codes that can be used for the parent and baby. Lactation consultations are billed according to time spent on the particular services rendered for *each* patient being examined at the visit. The ACA only covers preventative lactation care for the lactating parent. You can visit NWLC BREASTFEEDING TOOLKIT for more information regarding this coverage.
Thankfully, Aetna will provide some coverage for certain procedure codes for the baby during a lactation consultation. Any out-of-pocket costs are assigned by Aetna when they process the claim and are dependent on individual plans for the parent and baby. Aetna representatives may not disclose this if they are not aware that your child(ren) is/are considered a separate patient in a consultation.
As a courtesy, I like to provide my clients with details of their specific plan (if available) in order to estimate what may be due out-of-pocket for our visits. This will be emailed to you before our scheduled appointment for your financial consideration. Please see AETNA FAQs for more information regarding how Aetna covers lactation consultations.
If Aetna is only one of multiple insurances you carry and it is not set as your "primary" insurance - you will need to pay the Out-of-Network fee due at the time of the visit and be reimbursed if the claim is ultimately processed by Aetna.
If the baby is on a different insurance plan, the Out-of-Network fee will apply for baby and be due at the time of the visit. I will provide you with a Superbill after our visit that you will be able to submit to the insurance company to seek reimbursement.
If applicable, the "Long Distance Fee" (more than 20 miles travel) will be due at the time of visit and will not be covered by Aetna. You will be made aware if this fee applies to you.