For patients who have insurance coverage with
Aetna
As of 2024, Aetna has changed its coverage policy for lactation services. Here are some key points that you should know about lactation support if you have Aetna insurance.
Lactation visits involve multiple patients, are lengthy, and require several codes. (This is true for all visits and all insurance carriers.)
Lactation visits involve both the lactating parent as well as the baby
Visits for the lactating parent are covered as preventative under the Affordable Care Act of 2012 (ACA).
Visits for the baby are not considered to be preventative, so costs may be applied to your co-insurance or deductible.
Each visit lasts 1-1.5 hrs and multiple billing codes are needed for each visit.
A comprehensive visit will use at least two codes per patient, to accurately reflect the services provided.
Your six covered ‘visits’ is actually coverage for six procedure codes
Lactation visits involve both the lactating parent as well as the baby
Because multiple codes are used at each visit, this means that you may actually have coverage for 3 visits, not 6.
Some durable medical equipment (DME) companies that offer breastfeeding classes and pumps are billing the lactation support codes to your insurance company. This counts toward your six covered codes and reduces the amount of care that will be covered with a certified lactation consultant.
We are unable to verify insurance benefits for Aetna members
Please call your insurance plan to verify 2 things:
That you have coverage for lactation services
That Beyond Birth Collective, LLC is in-network for your plan