I bill Aetna directly. The repayment is based on the allowable amount by the insurance as well as whether the insurance deems it medically necessary as well as the patients deductible. Make sure before you see the patient you have all of the facts. For better results make sure there is documentation by the pediatrician either in the hospital or at the first ped visit of a need for lactation referral as medical necessity. I have been paid on one claim already, the other denied. Follow the AAP diagnosis codes and bill initial as 96150 and follow up as 96151.... Also ask insurance what their max payment for consults is in your area. I also disclose to clients a min. payment amount if insurance is denied upfront so it is not a surprise if insurance denies. Time to pay a claim is about 60 days so you have to have real goo bookkeeping and patient contact.

Hope this helps
Lisa

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