I am now a participating provider with the Aetna network. If your health insurance is through Aetna, your visits will usually be covered in full, with no out of pocket costs. I can file the claim directly, and no payment is required on your part. Of course you should call Aetna to discuss the specifics of your plan and ensure that this is the case for your specific plan. Please note that a few Aetna plans require referral from a physician. It is your responsibility to obtain such a referral if needed for insurance purposes.
Most private insurance companies are required by the Affordable Care Act to cover Out of Network lactation care without copay or deductible. However, the way this plays out in reality is complicated and depends a great deal on your individual policy, as well as how much time you put into talking with your insurance company.
I cannot guarantee that you will receive reimbursement and I cannot submit claims to insurance for you. You will need to do this yourself, after our visit(s). I will provide you with a Lactation Superbill with all the necessary codes that you can use to submit to your insurance company for reimbursement. You may also choose to use the Better app which makes it very easy to upload and submit your bill to your insurance company, and provides assistance in any appeals that may be necessary. They do take a small percentage of any reimbursement in payment for their service. See their website for details at https://getbetter.co/
If your time allows, I encourage you to call your insurance company before our visit, request pre-approval, and emphasize 1. that this is an urgent situation requiring an expedited decision (your baby needs to eat!), and 2. that there are no "In-Network" IBCLCs providing home visit lactation care in our area, so you will need to see an "Out-of-Network" provider. This can ease the process.
Even if you are not able to call in advance of your visit, I encourage you to submit your Lactation Superbill to your insurance company after your visit, and should reimbursement be initially denied, to appeal that decision. You are legally entitled to it! Some insurance companies, unfortunately, seem to routinely deny the first request, betting that tired new parents will just get discouraged and let it drop, but they will often reimburse if you are persistent.
The National Women's Law Center has some great information that you can refer to regarding your rights to insurance coverage for lactation care, and how to appeal any denials of claims: Toolkit Facts and Tools to Understand Your Coverage. You can also find helpful information, advice, and Sample Appeal Letters here, from an insurance savvy Lactation colleague in MA.
Schedule a Visit
Text or Telephone (518) 672-1519,
email to Sarah@HeartsWorkBreastfeeding.com
Weekend appointments are often available.
I make telehealth visits to anywhere with a good internet connection, and In Person visits within approximately 40 minutes drive of Chatham, NY, which includes all of Columbia County, and sections of Greene County, Renssalaer County, Albany County, and Dutchess County, NY, and Berkshire County, MA