Insurance companies are already indicating that they are recognizing that IBCLC is the certification that they should recognize and require.  Please let's not jump to work for an insurance company for less than fair market value out of  fear that someone else will step in and get there first.  This will only harm mothers and babies and will drive our profession and credential under.  
IBCLC's in private practice are almost universally in a precarious financial position.  Many are not breadwinners.  Let's not be so naive as to rush to a bargaining table without representation.  For the most part, it seems this will need to be done by state.  
Background information to help in the consideration of these issues:  
Know that medicaid reimbursement rates are highly important, because private insurers will try to base their rates off medicaid rates (NOT that you have to agree to them).  
Insurers will also try to base their rates off salaries of LC's in hospitals.  IRRELEVANT, unless they are to multiply those salaries by at least SIX to include the amount the hospital makes off its employees, the cost of doing business for the private practice LC, and the value of benefits.
The prices that IBCLC's in private practice are currently charging  are also IRRELEVANT, as there is not an IBCLC out there in private practice who is not working at less than fair market value  simply because we believe that mothers are not the ones who should bear the cost of our services.  It is NOT OK to allow our value to be based on our history of partial volunteerism and charitable intentions.  IF we allow this to happen, we will not be creating a viable and sustainable profession.  There will not even be enough IBCLC's entering the profession to be hired by new mothers  
 For now, we need to educate ourselves about what insurance companies and medicaid are paying other professions!
Please note that a speech therapist makes 110 in 30 MIINUTES.  Speech therapists will describe themselves as underpaid and they are underpaid, and they are lobbying for themselves.  Speech therapists are, like LC's, people who went into their profession because they wanted to help others.  110 for a 30 minute visit may sound like a lot, but it is not, if you delete the costs of running a business and the therapist is a breadwinner.  When valuing our services, we need to operate within a paradigm of women working, not just for fun money, but to support their families.  Now note that IBCLC's in private practice have been indicating that a visit, round trip, including correspondence with a physician takes 5 hours.  And IBCLC's cannot schedule appointments back to back at mothers' homes the way that speech therapists can.  And we have to wait for infants to wake up and be ready to feed.  Look at the reimbursement rates of OT and PT.  Is our value not at least as high as their work?
Why being an experienced negotiator matters--Know that a speech therapist in MA gets reimbursed 180 for the same code that a speech therapist in AL gets reimbursed 18.  Wow, I bet those speech therapists in AL wish they had not negotiated for themselves.  When they agreed to the rates, they probably thought they were getting a good deal.  
Our value--Now, wherever we may live, do we want medicaid to reimburse IBCLC's less than a speech therapist is reimbursed?  If so, why?  We know that we are not helping mothers and babies by devaluing our profession.
Refusing to join for less than fair market value--ex.--Dentists have for the most part refused to work for insurance companies that devalue their profession.
Negotiation--Know that physicians and other professionals negotiate their rates through attorneys, practice by practice, and their organizations have attorneys lobbying for legislation that supports their profession (i.e. not just breastfeeding in public laws, but legislation that requires insurance companies to reimburse for IBCLC's rather than other credentials and to pay for home visits, etc.).
Know that it would be extremely naive to approach an insurance company and start negotiating your own rates unless you are extremely experienced in valuing a business service and negotiating insurance rates.  And please do not negotiate rates unless they are based on what someone would charge as a breadwinner of the family who pays for health insurance, disability insurance and childcare.  In NY, those COSTS, including daycare for ONE child, are $47,000.  And we haven't even touched the cost of a vehicle, etc.  So that women will choose to pay for college courses to meet the IBLCE requirements and so that they will choose to enter this profession and so that they will be able to do right be their own children, let's be very wary of insurance companies undervaluing our profession.  (This will happen only if we let it!)
Warmly and protectively,
Maria Paciullo

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