Aetna Meritain

Does my Aetna insurance plan cover lactation consultations?

Home, office and virtual Lactation Services are fully covered with no copay by your Aetna health insurance. This includes prenatal education, lactation consultations, newborn, infant and child breastfeeding guidance; infant bottle feeding and first foods education; breast pump selection and education, flange fitting and breast pumping coaching appointments. Aetna considers this preventative care and provides 6 visits (or 3 Mother/Baby combined visits) for education and lactation care. 

After 6 (or 3 combined) visits, you can expect some patient responsibility/cost sharing. We can't predict, and Customer Service agents cannot guarantee, how much you will or will not pay. We submit your claim and after Aetna processes your claim, you will know exactly how much (if any) your patient responsibility is. We correct and resubmit a claim up to two times. After 2 denials of coverage, it is your responsibility to pay any unpaid fees, and argue with Aetna to recover your payment from them.

The easiest way to obtain your Aetna covered lactation appointment is to Request an Appointment here. We verify your account with Aetna Health within a few hours, and give you a covered lactation appointment in the time frame that you are requesting. You will need your Aetna insurance card to complete the request.

Other policies with the Aetna logo, such as Meritain, are also processed and receive similar benefits. 

If you previously obtained education through Aeroflow or consulted with another lactation consultant, your visits count towards your total with Aetna. You can see more than one Lactation Consultant if you choose. We would be honored for you to choose New Baby New Paltz/Donna Bruschi, IBCLC as a provider.

Provider Services for Aetna consider lactation consultation as preventative care, and they encourage 6 uses of the lactation class code S9443 per mother/baby dyad. This includes prenatal and postpartum visits. The mother/lactating parent is covered 100% with no copay. The baby may have a small ($6-10) patient responsibility cost that accompany specific time based consulting codes.

If a patient requires more than 6 visits, or only Baby has coverage, Aetna does cover visits with some cost sharing. With a typical home visit you could expect $61 patient responsibility. You can ask what your visit count is at any time.

Travel Fees may apply for a home visit more than 20 minutes from Highland, NY  (ref: Google Maps)

Home visit travel fee:

I specialize in home lactation consultations and I travel up to 90 minutes.  

+$0 -   up to 20 minutes from Highland, NY.
+$30 - 21 to 30 minutes from Highland, NY.
+$60 -  31 to 45 minutes from Highland, NY.
+$90 - 46 to 60 minutes from Highland, NY.
+$120 - 61 to 90 minutes from Highland, NY.

****************************************************

Request an Appointment here.

We check your insurance benefits and/or give you an appointment in the time frame you list as available. If you have a new baby or an urgent situation, your appointment will occur within a day or two.

******************************************************

If you need a self pay option:

Emergent Newborn Home appointment: 

• Meet within 24 hours, 90 mins - $300.   + Travel fee if needed.

Regular self pay options:

• 60 minute appointment - $175.    + Travel fee if needed.
• 90 minute appointment - $250.   + Travel fee if needed.
• 15 minute "Quick Question"; follow-up appointments; office or virtual only - $40.
  

I accept the following forms of payment:

Insurance pre-approval, cash, check, credit card, gift card, and Flex/HSA cards. Please let me know your preference on the intake form.

All clients must have a debit/credit/HSA card on file.

Your debit/credit/HSA card is used as backup payment source for a last-minute cancellations, co-pays, or if your insurance lapses. It can also be used to pay for lactation supplies, travel fees, and appointment fees as needed. 

Cancellation fees

When you cancel more than 48 hours before the appointment, there is a no cancellation fee and prepaid appointments are fully refunded.

If you are sick, you must reschedule your appointment. An appointment can be rescheduled for illness ONE TIME at no charge. If you cancel your rescheduled appointment, there is a 100% appointment cancellation fee.

When you cancel your appointment with less than 48 hours advance notice, a $175 appointment cancellation fee is immediately charged to your card on file.