Recently, I was asked to call the HMOs here in town to  see how they handle
nutrition counseling for their patients.  Naturally, I decided to ask about
breastfeeding while I had them on the line.  Here is what I found out.....


1. Most of them do not pay for breastfeeding support services as such (one
told me that if it is billed as "education and training" that they would pay.
 I think the NRV code is 942 (BEWARE:  most insurance companies avoid paying
for everything listed with this code....)

2. Most of these HMOs employ nurses to administer the case management part of
the program.  The nurses I spoke with did not think BF needed credentialed
individuals to assist with problems, after all, they (the individuals I spoke
with) had learned it all in nursing school.  (One of them told me she had
pain for the first week of nursing and decided she was going to give up if it
did not resolve in 24 more hours.  She did what her LL friend told her and
stopped the pain - sounds like she (the nurse) really knew how to help with
breastfeeding - {heavy sarcasm here})

3. I was told that pumps were usually not covered because they are a
convenience item.  If a baby is hospitalized, only one would provide an
electric pump.  One told me that there are good formulas out there that can
be supplemented with EBM if the mother is that determined to pump.  (Made it
hard for me to stay civil, but you all would have been proud of my control).

4. In every case, I asked them what type of information would be helpful to
them to learn more about the cost savings they would enjoy if more of their
babies were breastfed.  Every one of them said they had never thought of
that!!!!!

5. By keeping my cool, continuing to ask questions and offering information,
I was able to get one (the hardest sell) to tell me about an organization of
Insurance Professionals that meets bimonthly.  She wanted to know if I would
be interested in speaking to these people (YES
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!)


Which brings me to one of the points I want to make....  Does anyone have any
actual cost savings (dollar amounts per disease) formulas, data, numbers or
statistics to share with me.  I want to be ready if my phone rings.

This is a very opportune time to discuss cost savings with these people.  You
see, they do not think very many low income moms breastfeed and they are not
convinced that there are any problems.  I was able to bring in the NY Times
article about the bogus formula being sold as a risk factor and when I
started talking about how BF could save their companies money - I HAD THEIR
ATTENTION.  All of these Medicaid HMOs are capitated.  That means they get so
much $$ per person on their plan.  If the participants  do not use the
medical services as often, the plan makes money.  If the participants use the
medical services more often, the plan loses money.  Cost savings for BF
starts immediately, so even with plan switching by participants, these plans
could have savings.

(One plan said that even though they do not cover BF services routinely that
they would consider it and on a case by case basis & they could get an answer
in 2 weeks for an individual situation.  I told her the baby could be dead by
then if it was a FTT.  She said they COULD use a fax and get an answer sooner
if it was necessary......)

Please send me any information you may have.  You may privately e-mail me at
[log in to unmask]

Thanks in advance,
Martha, queen of stirring up all sorts of situations