In a message dated 11/11/2005 12:07:52 AM Eastern Standard Time,
[log in to unmask] writes:
A home health nurse would be such a wonderful program, but it is not
financially supported in many areas that need it. To the outsiders, it may seem like
a luxury, but it is often essential to the well-being of the family.
Dear Friends:
In the Philadelphia area, about 6 different insurance companies pay for
a well mother-baby visit in the first weeks after delivery. 2 companies will
pay for 2 visits. 2 other companies will pay for a lactation consultation at
home as well; the catch is that patients aren't told about this option! The
insurance companies don't want to pay for the LC visits and sometimes have to
be badgered into it.
As I work both inside (as a hospital LC) and outside, as a nurse for an
agency doing these well mother-well baby postpartum visits, I tell all the
mothers I see in hospital about this option, if they have the right insurance.
I tell them that they have to call the insurance case manager to ask for a
lactation visit; with one company, if the mother calls and pesters the case
manager she can have 2 lactation visits.
It is amazing to see that insurance companies think that a breastfeeding
problem will be resolved after one visit! I wish it were so......
Seeing dyads in the first week makes a huge difference and I am able to
be helpful.............sometimes. Often hospital practices have derailed
breastfeeding so much that the mother is ready to quit, even after a 2 hour visit
such as yesterday.
Yesterday's mother had huge breasts bursting with milk and had quit
breastfeeding for a day before I made the visit. ( Her referral to me didn't come
through until day 4, I saw her on day 5 postpartum.) After some hand
expression, and s2s in sidelying, the baby latched on comfortably and had a great
feed. Meanwhile, the mother leaked buckets of milk from the contralateral
breast, and soaked the bed. When the baby went to feed again, the mother had some
difficulty but was able to position so baby could latch. However, the mother
started worrying that I had been there "too long" and she was having a
girlfriend come visit, so she stopped, gave the baby a pacifier, pumped some milk
and said she planned to pump and bottlefeed.
I gave her names of the decent pump companies, suggested that she could
pump and bottlefeed until the big breasts shrank some, and encouraged brea
stfeeding as the goal. I don't know what I will find when I go back for the
second visit in a few days.
The whole visit was over 2 hours; I am paid $40 for this, and it doesn't
include the paperwork or travel.
Insurance companies put mother-baby visits at the bottom of the
reimbursement scale, based on the belief that mothers will keep their babies alive no
matter what, so there is no need to offer real service. Some companies
advertise that they offer mother-baby visits as a way to attract subscribers.
Another trend I am noticing is the discharge of premature infants way
too early. I am talking 34 and 35 weeks! The premies I have seen like this are
all readmitted for hyperbilirubinemia, as mothers aren't taught that
breastfeeding a premie is totally different to breastfeeding a term baby. What is
even more stupid is that timely homevisits to these early babies would save the
system lots of money as a nurse visit is cheaper than a readmission.
This is a slice of healthcare in the US.
sigh.
warmly,
Nikki Lee RN, MS, Mother of 2, IBCLC, CCE
Maternal-Child Adjunct Faculty Union Institute and University
Film Reviews Editor, Journal of Human Lactation
www.breastfeedingalwaysbest.com
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