Navigating Lactation Coverage: Aetna Policy Guide by Feedology

FEEDOLOGY, LLC AETNA INSURANCE FINANCIAL CONSENT POLICY: 

Aetna Insurance (in-network) clients: Claims for my care and my baby or babies care will be submitted directly to my insurance. If my insurance provider applies any portion to cost shares (deductible, copay or coinsurance), I will be invoiced and I agree to pay within 7 days for all applied charges for all visits. I fully understand that Aetna allows six lactation class codes (S9443) per 12 months. This code is the only code that Aetna reimburses at 100% for lactation consultation. I fully understand that more than one code, other than the S9443 code, will be submitted to my insurance for my visit, and my baby or babies visit, according to the visit type and services rendered to me and my baby or babies. I fully understand and agree to pay FEEDOLOGY, LLC for any and all cost shares that my insurance applies to my claims and to my baby or babies claims. My baby or babies and I will each have a separate claim submitted to our insurance, on our behalf, for each visit for services rendered by FEEDOLOGY, LLC.

FEEDOLOGY, LLC will submit a claim on behalf of myself and my baby or babies. If any portion of either claim is applied to cost-sharing in the form of deductible, copay or coinsurance, I fully understand that I am required by law and obligated to pay cost sharing to FEEDOLOGY, LLC. I will be invoiced upon receipt of the Explanation of Benefits (EOB) from my insurance, by FEEDOLOGY, LLC. 

Every effort will be made by FEEDOLOGY, LLC to have my insurance process and reimburse these claims. If any portion of these claims are denied, FEEDOLOGY, LLC will make every effort to appeal this decision. If the appeal attempt is unsuccessful, I will be responsible for the payment in full for each of these claims. If for any reason my insurance does not reimburse these claims, such as non-coverage or out of network, I fully understand that I will be responsible for the payment in full, at the self-pay rate, and I agree to pay in full, within 7 days of receipt of invoice. I will receive a superbill for this amount, and I can submit it to my insurance for possible reimbursement. I fully understand that I will not receive a refund issued to me from FEEDOLOGY, LLC. I also understand that my insurance may not reimburse me either. If my insurance does reimburse me at a less amount than what I paid FEEDOLOGY, LLC, I fully understand that I will not receive a refund from FEEDOLOGY, LLC for the difference.

If one of us (me or my baby or babies) are on different insurance and therefore out-of-network for FEEDOLOGY, LLC, I agree to pay the self-pay rate, up front, per visit. I will receive a superbill for this amount, and I can submit it to the insurance company for out-of-network insurance reimbursement. I fully understand that I will not receive a refund issued to me from FEEDOLOGY, LLC for any reason. I also understand that the insurance company may not reimburse me either. If the insurance company reimburses me at a less amount than what I paid FEEDOLOGY, LLC, I fully understand that I will not receive a refund from FEEDOLOGY, LLC for the difference.

If I have a primary insurance that is out-of-network for FEEDOLOGY, LLC, but a secondary insurance that is in network with FEEDOLOGY, LLC, then I understand that I must pay the full self-pay fee, up front, as a deposit. FEEDOLOGY, LLC will submit a claim on my behalf to my primary insurance, with the full understanding that my primary insurance may not reimburse FEEDOLOGY, LLC. Once a denial is received from my primary insurance, FEEDOLOGY, LLC will then submit a claim to my secondary insurance for reimbursement. I fully understand and agree that I will not be refunded for any amount that I have paid to FEEDOLOGY, LLC until FEEDOLOGY, LLC has received reimbursement by my insurance. I fully understand and agree that if my insurance applies a cost share to patient responsibility, that amount will be deducted from my refund that will be issued by FEEDOLOGY, LLC. I will only be refunded if and when FEEDOLOGY, LLC receives payment directly from either insurance, and only for the specific amounts paid by my insurance(s). FEEDOLOGY, LLC may keep any amount paid by my insurance(s) over and above the deposit I paid.

FEEDOLOGY, LLC is providing care to me and to my baby or babies; together we are all the client of FEEDOLOGY, LLC. A separate claim will be submitted for each of us to insurance, under each of our names separately. 

If I have booked a home visit, a travel fee may be applied based my location. I understand that this is not eligible for insurance reimbursement and must be paid prior to the visit. No refund will be given for this travel fee.

I am responsible to verify my own lactation benefits. FEEDOLOGY, LLC can only see that I am active with the insurance. They cannot see if I have any special circumstances that might prevent my insurance provider from covering services. If my plan denies coverage of lactation services after the claims have been submitted, I am responsible to pay at the self-pay rate. I understand I should refer to my plan benefits and call my insurance directly to verify lactation coverage. One specific code to inquire about is S9443. I agree to ask my insurance company if this code is a covered benefit on my policy. I will also verify with my insurance that my baby or babies are active and covered on my insurance policy. I agree to inform FEEDOLOGY, LLC if my baby or babies are not yet active on my insurance policy. I agree to also verify with my insurance that FEEDOLOGY, LLC is in network with my specific insurance plan prior to my visit. 

FEEDOLOGY, LLC may communicate with my insurance company in reference to the services provided to me and my baby or babies. FEEDOLOGY, LLC may communicate with my credit card company or bank for any payment related matters. It is my responsibility to provide accurate and current payment and insurance information. I will update my credit card information as needed and am responsible for any costs and fees associated with my failure to provide updated information.

These policies apply to FEEDOLOGY, LLC and its representatives.