Dear US IBCLCs,
This message is to clarify some things regarding insurance reimbursement.
For those of you who do not know, please see the links below to understand
the Affordable Care Act Requirements regarding cost-sharing and network
providers.
Cites breastfeeding as a preventive service
http://www.healthcare.gov/news/factsheets/2010/07/preventive-services-list.h
tml#CoveredPreventiveServicesforWomenIncludingPregnantWomen
For Michelle and Maria - Describes and defines "no cost sharing" and
"In-network"
http://www.healthcare.gov/law/features/rights/preventive-care/
Additionally, please realize that MEDICAID it is not subject to the ACA and
it is irrelevant here because IBCLCs cannot be "credentialed " Medicaid
providers since we do not have a license in any state.
Also, be advised that arguments being presented on this Lactnet are
reactionary and presumptuous. The single code that I have cited as a mere
example in the discussions is only one code. A PRE-EXISTING code that has
been, and is being used for provision of services by many health
professionals all over the US. This is a code which has established rates
assigned to it and that is what it pays. That single code which is being
argued about is for office visits, not home visits. It remains to be seen IF
HOME visits are going to be covered and what the reimbursement rate for
those will be. Also, Aetna is only one provider, insurance carriers have a
range of reimbursement as you should know. Some pay better than others.
Additionally, this is only a miniscule first step in the process and a
temporary / workable solution for the present time.
The USLCA has applied to CMS for our own codes specific to our visits, long
definitions below. If those codes are approved then the associated fee
schedules are next to be negotiated.
In-Patient:
Lactation evaluation and management by a qualified lactation consultant, in
patient hospital
Brief visit (often happens when immediate problem is identified and patient
is not scheduled):
Lactation counseling and/or breastfeeding risk factor reduction
intervention(s) provided to an individual; approximately 15 minutes
Out-patient, Office:
Lactation evaluation and management by a qualified lactation consultant,
initial out-patient office visit, 60- 120 minutes
[to include at least the following: (1) maternal, infant, birth and feeding
comprehensive history, (2) a physical examination that includes: (a)
maternal nipple and breast (b) infant oral anatomy (c) infant suck
assessment (3) feeding observation and (4) problem assessment, and (5)
management plan and patient education]
Lactation evaluation and management by a qualified lactation consultant,
follow-up out-patient office visit, 40-90 minutes
[to include at least the following: (1) maternal, infant, birth and feeding
pertinent history, (2) a limited physical examination that includes: (a)
maternal nipple and breast (b) infant oral anatomy (c) infant suck
assessment (3) feeding observation and (4) updated problem assessment, and
(5) revised management plan and patient education]
Out-patient, Home:
Lactation evaluation and management by a qualified lactation consultant,
home health visit, initial, 60- 120 minutes
[to include at least the following: (1) maternal, infant, birth and feeding
comprehensive history, (2) a physical examination that includes: (a)
maternal nipple and breast (b) infant oral anatomy (c) infant suck
assessment (3) feeding observation and (4) problem assessment, and (5)
management plan and patient education]
Lactation evaluation and management by a qualified lactation consultant,
home health visit, follow-up, 40-90 minutes
[to include at least the following: (1) maternal, infant, birth and feeding
pertinent history, (2) a limited physical examination that includes: (a)
maternal nipple and breast (b) infant oral anatomy (c) infant suck
assessment (3) feeding observation and (4) updated problem assessment, and
(5) revised management plan and patient education]
Classes, Prenatal or Return to Work:
S9443 Lactation Classes, Non-Physician Provider, Per Session
Apparently our detractors not a dues paying ILCA/ USLCA member, or if they
are, then they do not care to read the eNews which comes monthly and has
been providing information on this regularly. They seem to be aware of all
of these efforts made by USLCA for the past 6 years as one of its main
missions?
Perhaps since they consider themselves the "good IBCLC " providers ~ and
they are so successful at getting high rates of reimbursement ~ they could
have shared some of their knowledge, time and talents with you and USLCA
-their peers - to prevent those of us who have good intentions, but who are
ignorantly moving our profession in the wrong direction, from violating
their requirements. Perhaps if they had contributed to this work, by now we
would all be getting paid $300 for consults and all the women in the US
would have access to adequate breastfeeding support and our breastfeeding
duration rates would be exceeding the Healthy People 2020 goals. Perhaps
rather than issuing argumentative challenges even this week, they could have
used a tone of kindness and offered help and cooperation. Maybe they would
even donate funds for some attorney fees since you they are the few IBCLCs
who are paid well.
I am only one among many, including Marsha, at USLCA who give countless
volunteer hours - daily - and we contribute financially by dues and other
incurred costs of working for the USLCA Licensure and Reimbursement
Committee. I work 3 or 4 part-time jobs as an IBCLC, all in the out-patient
setting. I do not get health benefits. I do not attend the Conferences often
( 3 since becoming and IBCLC 17 years ago) because I can't afford it. I am a
good IBCLC regardless of getting paid only $30 an hour. I also help lots of
women volunteering as a LLL Leader for 24 years. I volunteer for my state
and local breastfeeding coalitions and my local USLCA chapter as well. I
really don't like being attacked. It is unnecessary and counterproductive.
We could be solving these problems together rather than this mean spirited
dialogue.
Judith L. Gutowski, BA, IBCLC, RLC
***********************************************
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
|
