Erika asks whether the insurance companies reimburse nonRNs.  I have offered insurance forms to my clients even when I was a trainee under supervision of my mentors.  I know CLCs and doulas (actually some with the combo) who were able to get reinsurance reimbursement.  I provide a superbill with CPT codes and ICD-9 codes.  In the last month or two I've actually had insurance companies taking more measures to actually reimburse their clients, especially the company that always overlooks what is already on the forms.  In fact, one of the agents actually commented on how great it was that they were reimbursing for breastfeeding assistance and how great it will be when it expands. 

So, YES, here in New York City I at least am seeing the impact of the Affordable Care Act improving a) my clients ability to seek breastfeeding services and b) my ability as a small business owner to retain health insurance for "pre-existing conditions" even if my husband or I should ever have a lapse in our insurance.  The latter, as a small woman-owned business owner is crucial for survival should either of us have a period of time when we cannot afford health insurance we have enough preexisting conditions that we would be doomed should we have a lapse in our ability to pay for health insurance.

Quite frankly, I am afraid that in the United States we may lose some of the gains we have achieved with insurance reimbursement and removing the promotional sample kickback model of hospitals distributing only one brand of formula while ignoring many other alternatives for women who cannot fully feed their babies from the breast -- such as expressing mom's own milk or human donor milk.  And as I recently posted, the larger issue of the US government subsidizing the formula industry's in their efforts to coerce women into formula feeding on the taxpayers dime.   The Massachussetts Breastfeeding Coalition reminds us that sometimes our politicians are not breastfeeding friendly.  

http://massbreastfeeding.org/index.php/2012/romney-and-banning-the-bags-the-back-story/

As for WHAT the insurance companies reimburse -- here in New York City the companies so far seem to be reimbursing at the rate that those of us in New York City charge for the 2-3 hour visits that it takes even the most experienced IBCLCs in the city to conduct a FULL ASSESSMENT including weight gain and milk intake of our clients.  That range is between $200-$400, with $250 being the median for those who work predominantly in Manhattan. (There is one outlier who charges by the hour and asks for tea on the client's dime -- but she is an outlier and doesn't really interact with the rest of the IBCLCs in the city).  No one gets rich on that - it reflects the cost of living in New York City and quite frankly, for those who are in families for which that is the sole income, it really doesn't even put you in the category of a middle class income by Manhattan standards.

 Sincerely, Susan E. Burger

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