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.)

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

Referrals

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.

Aetna, Cigna and Oxford–some plans require referrals.
Anthem Blue Cross Blue Shield from states other than Connecticut–some plans require referrals.

IMPORTANT
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.”

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 AmeriChoice, Anthem Blue Cross Blue Shield of CT, ConnectiCare, EDS, PHCS or United Health Care.

Two patients, two referrals, two co-pays

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 find out about both of 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:
So, if you need a referral, we will likely need a referral from both your doctor and your baby’s doctor.
Two co-pays:
And, if we need to 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 only 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, and difficult to predict.
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 always receive a bill at our regular charges, if our charges would create a financial hardship, we can always adjust something to make it affordable for you.
This can include reducing or waiving some charges and/or working out a payment plan.
Most problems are solved with a visit or two, but if it takes longer, we will do what we can to make sure that finances don’t get in your way.