(Aetna and subsidiary companies & CIGNA)
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I have an existing contract with Aetna and Cigna 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".
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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. Your baby will likely receive some coverage for these consultations, but be aware that insurance representatives may not disclose that your baby is considered a separate patient. Any out-of-pocket costs are assigned by the insurance companies (cost-share) when they process the claim and any balances will be invoiced to you.
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Recently, CIGNA has allowed me In-Network. They will cover lactation consultations at 100%, without limit to the amount of consultations (per CIGNA at this time). You can verify that I am In-Network with your plan if you see my name on your directory or by calling them for verification.
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FOR AETNA:
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.
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​​If Aetna/CIGNA 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/CIGNA.
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If the baby is on a different insurance plan from Aetna/CIGNA, 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.
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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 insurance. You will be made aware if this fee applies to you. *This is separate from the "Home Visit" insurance code that may be billed for services.*