Aetna Healthcare Insurance Coverage and Financial Responsibility
PLEASE READ CAREFULLY
Anna Mroczek (Ania) RN, IBCLC is in-network with most Aetna plans, and most Aetna plans “cover” lactation services as in-network care.
Covered does not equal free. When Aetna states that a member has 6 “free” lactation visits, they mean 6 uses of S9443 breastfeeding class code – not 6 visits.
The first six uses of S9443 typically have no cost sharing. These S9443 codes are shared between the mother and baby
In addition to S9443, other codes are billed to ensure our time is fully compensated. These other codes may incur cost sharing.
The six S9443 codes are typically used up after 3 visits. Subsequent uses of this code typically result in cost sharing for mother and baby each, per visit.
Patients are responsible for verifying that their Aetna benefits are active, specifically cover lactation services, and confirming their coverage details with Aetna before scheduling appointments, using the table of codes provided at the bottom of the page. Mohawk Valley Lactation does not verify benefits or process insurance in advance to ensure coverage.
Patients are ultimately responsible for all fees associated with their visit. All copays, coinsurance, amounts applied to deductibles, and non-covered services, as determined by their insurance plan, will be charged to patient.
Aeroflow Users
If you obtained your pump from Aeroflow, please note that they bundle “classes” with breast pump purchases and that each “class” you sign up for uses one S9443 code. This may affect your out of pocket costs. If you find this to be the case with your coverage and weren’t informed of this, we encourage you to contact the New York State Insurance Commissioner to file a complaint.
Other Providers
If you’ve seen other private practice lactation providers, it is likely that some or all of your S9443 codes have been depleted. This may affect your out of pocket costs.
Financial Responsibility
You will be charged in the situations listed below.
If you believe a charge was made in error, please contact our office immediately. We will reverse charges promptly if the error is confirmed. If the issue lies with your insurance processing, charges will only be reversed after the claim is reprocessed and corrected by your insurer.
• Patient Responsibility: When Aetna processes your claim, patient responsibility may be assigned (e.g., copay, coinsurance, or deductible).