​​​Aetna Information:

Regarding your Aetna plan, please read the following and confirm receipt and understanding. I need to ensure you have a good understanding of potential out-of-pocket costs.

• If your baby is not covered by Aetna, an additional $125 fee will apply and a claim (superbill) will be provided to you. 

• A $150 Home Visit Convenience Fee applies for any in-person Home visit and is not eligible for insurance coverage. Office Visits are available without this fee.

•  Aetna often states you have 6 "free" lactation visits. They are referring to 6 S9443 codes. This code has no associated cost-sharing (copay, coinsurance, deductible) for the first 6 uses but does not pay well enough to be billed as a stand-alone code. Aetna has now recently reduced the number of S9443 allowed to less than 6.

• At each visit, I bill S9443 for the mom and the baby (assuming both are present), in addition to appropriate office visit or home visit codes

• Cost-sharing can be applied to those home or office codes for mom, baby, or both when the visit is longer than 30 minutes. My visits are typically 60-120 minutes.

• Copays or coinsurance are not always applied to these codes, but when they are, they commonly range from $13 to $60 for either the mother, the baby, or both, with an average of around $80 per visit.

• When deductibles have not been met at the beginning of the year, you can expect to see more cost-sharing.

• Starting March 1, 2024, Aetna changed its policies to avoid paying preventive codes for infant feeding services. Even if Aetna tells you you are covered for free, most plans will assign a cost share for your child's claim for their services. All cost share assigned will be charged to your credit card on file. 

• Please note that I cannot guarantee the exact costs due to the variability of Aetna plans and unreliable cost estimates from Aetna.

 

United HealthCare Information:​

• If your baby is not covered by United HealthCare, an additional $125 fee will apply and a claim (superbill) will be provided to you. 

• A $150 Home Visit Convenience Fee applies for any in-person Home visit and is not eligible for insurance coverage. Office Visits are available without this fee.

• While I am in-network with United HealthCare, and there is not supposed to be any cost-sharing, you will be charged for any cost-sharing that United HealthCare applies.

​You are responsible for any deductibles, co-pays, or co-insurance that may be required.
Please verify coverage amounts for in-person consults with your own Aetna & United HealthCare plan. 

 

Telehealth Consultations are not covered by insurance at this time. 

 

​When calling your insurance company regarding benefits or to check if I participate in your plan you will be asked for the following information:

Provider Name: Cathleen Walker
Business name: Lactation Consultant At Home, LLC
NPI #: 1710343249

Ask for a reference number for the call and record the date.