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:

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.
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.
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.
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.

Generally speaking, after 3-6 visits, your lactation care with Aetna MAY involve some level of cost sharing. Please read on for further details.

UPDATE: Billing in Network For United Healthcare Clients

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UHC has changed their coding guidelines and will no longer accept S9443 as an allowed charge for infants as of 9/1/26.

With this change, we unfortunately may see a higher cost share for any infants billed with a UHC or related plan. Cost share will likely be a specialist copay and subject to deductible, depending on employer. Cost share will vary anywhere from $10 to approximately $100 depending on the employer’s plan type. We apologize for the inconvenience and encourage you to reach out to United Healthcare and express your concerns for this policy change.

Payment Policy:

Payment Policy

Aetna and United Healthcare Insurance Covered Clients: We are an in-network provider with Aetna and United Healthcare. If you are covered by Aetna or United Healthcare, we will submit claims directly to your insurance company on your behalf.

Client Responsibility with Aetna/United Healthcare Coverage

You are responsible for any copayments, cost-sharing, deductibles, and non-covered services as determined by your insurance plan.
If your insurance denies coverage or determines that a portion of the fee is your responsibility, your card on file will be charged for the balance.
You are responsible for understanding your insurance benefits, including whether lactation services are covered, how many visits are allowed, and any potential out-of-pocket costs.
With recent changes to United Healthcare's lactation coverage policies, effective 9/1/26, please expect to have cost sharing to your visit when bringing your baby to be seen for an appointment with us. This is a brand new policy change but we are expecting cost sharing to range from $10-100 per visit. We will update this policy as soon as more information is known.