So I got a lactation consultant. That's someone who comes to your hospital room or home to help you nurse. It seems silly to anyone who hasn't nursed before, but babies don't know anything. They don't know how to get milk from your breasts. You actually have to get them to "latch" on AND I have two babies with two different personalities and development levels.
Your nipples crack & bleed. Your body can make too much milk or not enough. It's painful. It's stressful to have a screaming, hungry baby in your arms, but the baby won't connect with your nipple to eat. There are experts who help make sure you're getting the hang of it early on AND they're covered by insurance, which is great.
Aetna tells me that this is covered for 6 in-home visits, 100%, no cost to me. They ALSO tell me that there are no covered lactation consultants in my area, so I can use any one that I want and they will pay for it.
I have been on the phone with them for 30 minutes, where they are telling me this service isn't covered because I used an out of network provider AND she used the wrong code on the forms. The consultants know the insurance companies are full of it, so they make you pay them, then you have to follow up with the insurance.
Aetna can't give me the code. My LC is not an in-network provider, so she has no access to the codes. Seems like a dead end to me.
Unfortunately Aetna, I'm not going. I am currently nursing a screaming baby and still on the phone with them. I haven't eaten or showered today, but I've used 45 minutes to track down money that should have just automatically come to me. This is my second call today. You know I have SO MUCH free time with 4 week old twins who eat 8-10 times a day and don't sleep for more than two hours at a time...
So far, my options seem to be:
1. Change the code and see if they'll pay for it.
2. Fill out a post-service out of network provider authorization and see if they'll pay for it.
3. File an appeal (if neither of those work)
Aetna has me confused if they think they're not paying this claim. I will call the better business bureau, the attorney general's office, the Hillary Clinton campaign... I will create a PR campaign against the insurance companies... I won't stop until I get my money back.
If they would just give me accurate information when I call and none of this would have happened. Why would I CHOOSE to use an out-of-network provider if I thought it wasn't going to be covered. You know living in New York and having two children, I have SO MUCH extra money for frills and thrills. Jerks.