INSURANCE

We are providers for the following companies:

Aetna
Anthem Blue Cross Blue Shield of Connecticut
Cigna
ConnectiCare
EDS (Medicaid)
HUSKY (A & B)
Oxford
PHCS
United Health Care

HMOs and Insurance Companies

We are on the panels of nearly all HMOs and health insurance companies in the area.
We are NOT on Yale Health Plan (If you are on YHP, scroll below.)

FAQS

REFERRALS

**IMPORTANT**

Each insurance company has many different health plans. Some require referrals, some don’t.If you are on one of the following company’s plans and don’t know if you need a referral, you will need to check with your insurance company.

When you call to find out, ask if you need a referral to see a “MEDICAL SPECIALIST.”
We are a medical specialty practice, providing care in the field of Breastfeeding Medicine.

Although we have lactation consultants on staff, we are NOT a “lactation consulting” business.
Most insurance plans in Connecticut do NOT cover “lactation consulting.”
So you are quite likely to accidentally get the wrong answer if you use the word “lactation.”

AETNA, CIGNA, OXFORD: some plans require referrals.

ANTHEM CROSS BLUE SHIELD: for states other than Connecticut–some plans require referrals.

CIGNA: If your Cigna plan requires a referral, a simple paper referral request written on the doctor’s prescription pad or office stationery should be in our hands within a week or so of your first visit to our office.

AETNA and OXFORD: referral plans usually require a faxed or electronic referral directly from your doctor’s office to us.

NO referral is required for any of the insurance plans offered by Anthem Blue Cross Blue Shield of CT, ConnectiCare, EDS, PHCS or United Health Care.

TWO SERVICES

Breastfeeding is a two-person process.

To understand what is going on in most breastfeeding situations, we usually need to see both you and your baby, and often, watch a feeding. Then we work with you to develop plans to help both you and your baby.

Two referrals:
If your insurance company requires a referral, we will likely need a referral from both your doctor and your baby’s doctor. These referrals need to be received and processed by our office before your appointment.

Two co-pays:
If we evaluate both you and your baby, we will usually collect two co-pays.

One co-pay:
We do NOT collect two co-pays if the situation really only involves mother or baby only.
(It’s still OK to bring your baby along, even if your baby doesn’t have a feeding problem, other health/medical problem, or any issue that might be causing or affected by your problem)
And we also do not collect two co-pays if to do so would be a financial hardship or keep you from getting the care you need.

Co-pays - Are they for a “specialist” or for “primary care”?

Each plan is different and changing all the time. It is difficult to predict how each plan approaches co-pays, so we always just charge the Primary Care co-pay.

If we should have charged you the specialist co-pay, we can always bill you the balance later.

Fee for service, out of pocket payments:

If you are on Yale Health Plan, are uninsured, or your insurance plan does not cover us, we want to work things out to allow you to get the care you need.

Although you will receive a bill for the full amount due, we may be able to work out an adjustment to your charges. A payment plan can also be set up as an option.