Response to Susan and Jaye's concerns:

Susan, 
The preventive services counseling codes are standard existing codes used
for billing among all types of health professionals. We cannot change them
or the fees associated with them. The fees associated with the codes may
vary by insurance carriers and will also vary by location of services
provided. Have you checked to see what the code will pay in New York? These
services are not specific to home visits and do not cover travel time or
travel expenses. If IBCLCs get paid better another way then they do not have
to become providers for Aetna. 

In surveys of IBCLCs distributed in 2008 by USLCA, and distributed in 2011
by IBLCE, the majority of respondents indicated that their wages were
between $25 and $39 per hour. The example of fees for services associated
with the maximum preventive counseling 60 minute visit yielded reimbursement
amounts between $93 and $123 among 4 states that were checked in the east,
central and western parts of the US. Assuming 1-2 hours of consult time and
the additional administrative and documentation time of 1 hour these fees
seem within the range of usual income for IBCLCs an will be an increase for
many. 

Unfortunately, travel time and expenses cannot be covered by medical
insurance. The Affordable Care Act specifically states that the preventive
health services must provided with no cost share to the patient either so
they cannot be charged separately for the luxury of the "home visit" rather
than going to an office. If your IBCLCs have different codes that they
utilize for the home visit, other than the "preventive counseling" codes we
can certainly present these to Aetna and discuss reimbursement for other
codes.  

It is our hope that more IBCLCs will be able to gain enough clients to
support opening private practice offices or will have more opportunities to
be employed in clinics or physician practices since this coverage is
available. Additionally, we are in the process of working on the option for
lactation visits to be done electronically for locations that are remote or
distant from any IBCLC providers for Aetna. While I know it is not ideal, if
a mother and baby can be visualized via Skype and the lactation consultant
can demonstrate techniques with a doll model this may help many mothers and
IBCLCs to connect.  

Jaye,
Your concerns about documentation discrepancies between physicians and
IBCLCs are not relevant. The IBCLCs will be providing "preventive
counseling" and a physician assessment of an infant feeding problem would
not have anything to do with this billing. I must assume that prosthesis is
"ordered" by a physician and there must be some common diagnosis for each of
them. Preventive health care is not going to be ordered by the physician. 


That being said, it is the responsibility of all IBCLCs according to our
Code of Conduct to provide documentation of a consultation to the mother and
the infant's primary care provider. This would not have anything to do with
billing. 

Judith L. Gutowski, BA, IBCLC, RLC

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