Hi All,

I have a comment/question about all this and wonder if there may be an
alternative option.  

First I understand that we don't have to be on a provider list and we don't
have to accept insurance reimbursement if that reimbursement is
significantly less than what we earn with consults.  That is easy enough to
grasp.  

I also understand that there will be moms who receive less than decent care
by those who will take the Ins. Reimbursement because the good LC's can't
afford to.  This is a problem.  We all know that mother's deserve quality
care, whether they can afford it or not, and we all want them to have it.  

So why can't we do what my Dentist does?  He charges $X for a service.  The
patient knows they are financially responsible for that service and pays for
that service in full.  Dr. sends a claim to the insurance company who
reimburses him $Y amount.  Then Dr. reimburses the patient $Z:  $X - $Y = $Z
In this manner, the patient gets proper care without paying the full price,
the Dr. gets to treat patient and does get his full price.  That is a
win-win for all.  The Insurance companies can't tell us we cannot do that
can they?  And when clients call and say "My Ins. Company said I'd get my
session for free..." We can explain the situation.  

If Aetna reimburses me $123 for the visit, that actually pays me $3 more
than my actual $120 flat fee.  For me, reimbursement isn't a big issue
financially as it clearly will be for others.  However, if they only pay
$93, then yes that is a problem.  However, I seriously doubt my clients will
have an issue handing me a check for $30 for a 2-3 hour visit that is nearly
fully covered by their insurance...

I feel that we have a long way to go with this - there are many questions to
be answered and likely, in time, they will all be answered and we will be
able to serve the moms we want to while still making a living wage.  

Warmly,
Jaye

Jaye Simpson, CLE, IBCLC, CIIM, MoM
Breastfeeding Network
www.breastfeedingnetwork.net

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