HELP!  During the last week or so, I have been inundated with calls for help
from the local county hospital.  (Yeh, Maryelle, we're finally making some
headway!!)  While that is great news and a huge step forward for them, I'm
having a dilemna about getting reimbursed for the consults.  Most of the moms
are WIC recipients under the city's clinics; my contract with WIC covers my
consult and products costs for those mothers.  But a few of these moms are on
Medicaid which doesn't consider breastfeeding important and doesn't reimburse
for pumps let alone for consults.  If the moms have preterm or very ill
infants, I can find a local agency to cover the cost of the pump.  But I'm at
a loss as to the consult fees.  The mom I spent 3 hours with last night in
the NICU, and whom I'll see again this morning, is a prime example.  An 18 yr
old primip, physician admitted her 2 day old for severe dehydration and
called me to come "fix the problem"!  Because I know the staff there doesn't
have the background in lactation to help her, I went anyway (too
soft-hearted??) and found a little guy who was almost comatose from caloric
deprivation.  Bless the resident's heart, she didn't even want an IV in him!
 But this little guy was starving, literally, and after two hours of trying
to get something down him with no success, we resorted to a bottle.  It took
30 mins to get 24cc's of ABM into him.  I'm hoping the feeds through the
night will have this little one ready to learn breastfeeding this morning.
 I'll end up billing the family, but knowing their status, I'll probably end
up writing the majority of the charges off at the end of the year.  Has
anyone been successful in their dealings with Medicaid??  They've told me "a
breastpump is a luxury, even for the mother of a 25 weeker", UGH!  Any
suggestions on alternative funding sources?  Looking forward to brainstorming
with ya'll.

Kathy Parkes, RN, IBCLC
San Antonio, TX