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Billing in Network For Aetna Clients

Effective September 2024, Aetna has implemented new coding guidelines for lactation services. As a result, we are required to adjust our financial policies to comply with these new requirements. These changes will ensure that we continue to provide you with the highest quality of care while aligning with the updated insurance protocols.

What This Means for You:

  1. Revised Billing Procedures: You may notice changes in how your lactation services are billed. We will now be required to use specific codes as outlined by Aetna, which could affect your out-of-pocket costs.

  2. Updated Financial Policies: To comply with Aetna’s guidelines, we have updated our financial policies. This includes adjustments to co-pays, deductibles, and other billing practices. We are committed to transparency and will provide you with a clear breakdown of any costs associated with your services.

  3. Insurance Verification: We strongly encourage you to verify your benefits with Aetna prior to your appointment. This will help you understand your coverage and any potential costs you may incur.

  4. Payment Responsibilities: Please be prepared for potential changes in your payment responsibilities. Our team is available to assist you in understanding your financial obligations and to answer any questions you may have.

FINANCIAL CONSENT POLICY

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Strong as a Mother, LLC - Aetna Insurance Financial Consent Policy (you will sign acknowledgement for this policy this in your lactation intake form)

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For clients covered by Aetna Insurance (in-network):

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  1. Claims Submission: Claims for services provided to both me and my baby or babies will be submitted directly to Aetna Insurance. If my insurance imposes any cost-sharing requirements (e.g., deductible, copay, or coinsurance), I will receive an invoice and agree to settle these charges within 90 days for all visits.

  2. Lactation Class Coverage: Aetna reimburses lactation consultations at 100% for up to six sessions per 12 months under the code S9443. If multiple codes are used for services rendered, I understand that I will be responsible for any costs not fully covered by this code. Each of us will have separate claims submitted to insurance for services provided.

  3. Claim Denials and Appeals: Strong as a Mother, LLC will make efforts to ensure claims are processed and reimbursed by my insurance. In the event of a claim denial, the practice will attempt to appeal. If the appeal is unsuccessful, I will be liable for the full amount of the claim. If my insurance does not cover the claims due to reasons such as non-coverage or out-of-network status, I will be responsible for paying the full amount at the self-pay rate within 90 days of receiving the invoice. I will receive a superbill for such payments and may seek reimbursement from my insurance, though I understand that Strong as a Mother, LLC will not issue a refund.

  4. Out-of-Network Insurance: If my or my baby’s insurance is out-of-network, I agree to pay the self-pay rate upfront per visit. A superbill will be provided for potential reimbursement from my insurance company. Refunds from Strong as a Mother, LLC will not be issued for any amount paid, and the insurance company might not reimburse me fully either.

  5. Primary and Secondary Insurance: If I have out-of-network primary insurance but in-network secondary insurance with Strong as a Mother, LLC, I must pay the self-pay fee upfront. Strong as a Mother, LLC will first submit a claim to the primary insurance, and after denial, will submit to the secondary insurance. Refunds will only be issued after Strong as a Mother, LLC receives payment from the insurance and only for the amounts covered by insurance. Any excess payment from insurance will be retained by Strong as a Mother, LLC.

  6. Client Identification and Separate Claims: Each of us (myself and my baby or babies) will have individual claims submitted to insurance under our separate names.

  7. Home Visits and Travel Fees: If a home visit is scheduled, a travel fee may apply based on my location. This fee is not eligible for insurance reimbursement and must be paid prior to the visit. No refunds will be given for this travel fee.

  8. Benefit Verification: I am responsible for verifying my lactation benefits directly with my insurance. Strong as a Mother, LLC can confirm insurance activity but cannot determine specific coverage details or special conditions that might affect coverage. I should check whether my plan covers lactation services, particularly under the code S9443, and ensure my baby or babies are covered. I will inform Strong as a Mother, LLC if there are issues with coverage or if Strong as a Mother, LLC is not in-network with my insurance.

  9. Communication and Information: Strong as a Mother, LLC may contact my insurance company or my financial institution regarding payment matters. It is my responsibility to provide accurate and up-to-date payment and insurance information and to update it as necessary. I will be responsible for any costs or fees incurred due to outdated or incorrect information.

These policies apply to Strong as a Mother, LLC and its representatives.

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