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Date: | Thu, 14 Feb 2013 22:32:19 -0500 |
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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
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