In a message dated 2/14/2013 9:29:56 P.M. Eastern Standard Time, Judy _G_ 
(mailto:[log in to unmask])  writes:

Aetna's  coverage policy for their in-network providers specifies which 
codes  should  be used and does not include codes for nurse visits which are  
meant to be
5-10 min visits and yield reimbursement of <$20. I suggest  not using the 
nurse code (99211) regardless of whether you work in-network or  out of
network due to this problem. 
~~~ 
Just in case it was confusing, I was not referring to  Aetna in this 
sentence. It was another insurance company, and the mom said she  was told she was 
speaking to a nurse, who told her that all lactation  consultants are 
nurses. This was not Aetna's error. I was also told by  another insurance 
company, regarding another client, that LCs "might use  something like" the RN 
codes. I explained this would be fraud and I  refused. The mother has been 
waiting 11 months for reimbursement, having  resubmitted twice or three times as 
the company instructed us. This is the  kind of delaying and confusing 
tactics companies use.  I think it's  criminal that they get away with this. 
 
Peace,
Judy
 
 
Judy LeVan  Fram, PT, IBCLC, LLLL
Brooklyn, NY,  USA
[log in to unmask]

 
 



             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome