The hospital I worked at got good results in receiving insurance payment by having an MD order (which we were always able to get-even docs not on staff would fax an order once they found out what we were about).  The other factor was that we always admitted the baby to outpatient, not the mother.  We would use the diagnosis of "feeding problem".  Even if the initial concern/problem was with the mother such as sore nipples, breast problems, maternal illness or disability, in the long run, the infant's feeding was impacted.  I think the powers that be felt if it was listed as a "mother problem" then the insurance was likely to consider our consult to be a form of "patient education" and thus not covered.

Sometimes we have to "play along" to reach our goal (facilitating the nursing dyad to get help and have help in paying) while at the same time continuing to educate the insurance companies.

Winnie

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