Dear Ruth, I've done both.  If it was a hospital pt I continued to see her
through the hospital.  Before I began work there I had arranged for them to
absorb any post partum visits needed.  Some moms stopped by the hospital
and some I stopped by their home and turned time in. They would not pay
mileage, but fortunately my home was one end of county and hospital at
other, so most visits were done on way to and from work. Have this clear
with the hospital before you start! Of course this was 10 years ago.  I
think now, with the good examples we've seen of hosp run BF clinics they
can figure out a way to bill ins for your services.  For instance the
hospital could put you under their visiting nurse group and pick up payment
that way. If you see them in your office at hospital they could bill for an
outpt service. There are CPT codes available for most breastfeeding
problems now.

If it was someone who called from the outside I saw her as a regular
referral.  If it was someone who comes to my LLL group I didn't charge.
(and still don't charge, I'm one of those anomalies who is still a LLLL and
LC).   It's hard to keep the 3 roles separate, but it can be done.  What
you need to do is NOT self refer.  It's not ethical.  In the rare instance
if I did self refer for whatever reason, rapport with mom or feeling that I
could handle this more easily than passing it on, I simply didn't charge.
I was also able to refer hosp pts who needed more than I had time for, to
other LCs in the area, in whom I had confidence.

I feel you can get around some of the referral problems by having a generic
LC list and generic pump list and give these lists to each pt in a BF
packet (containing how to know if your BF baby is getting enough, Kay
Hoover's BF Log for 1st week, How to hand express -Marmet sheet,
positioning info & pix, list of local LLL groups and #s, pump list and LC
list. This packet follows Chris' "rules" of what every PP mom needs to know
1)How to get baby on and off without it hurting, 2)How to know if baby is
getting enough, 3)How to know if you need help and 4) Where to get help. It
also follows the KISS rule because PP moms go home with TONS of stuff and
need to be able to sort out what is important and what can wait 6 weeks to
read!)

Sincerely, Pat in SNJ, USA