Hello Wise Ones,
Well, it's started. I am now getting calls from moms looking for lactation
consultants in network, but their insurance company cannot provide them
with any names actually in their network. The mom also said that the insurance
company told her all lactation consultants are nurses, so she should get
the lactation consultant to bill as a nurse doing a post-partum visit,
and/or many are working in pediatric offices so they can get a private
consultation in their pediatrician's office and that would be covered. As I am not a
nurse, and do not work for a pediatrician, the mom chose not to make an
appointment with me. As I watch the company my husband, with his other allied
healthcare professionals, has worked for go down under the burden of
excessive paperwork and denied, delayed, taken back, and lowered reimbursement,
I see a hard road ahead for new moms and "old" solo lactation consultants.
As a company of certified ( not licensed*, though) professionals, they were
always reimbursed for appropriate services by insurance companies, as well
as Medicare and Medicaid. They have an entire department of specialists
which had to be put into place to deal with the onerous and ever-changing
rules governing reimbursement. Everyone is salaried, so a slow week or month
or three months did not mean no one eats or pays bills. As a private solo
practitioner, my work has been a labor of love for the importance of healthy
breastfeeding relationships and the emergence of love and connectedness in
families. If this sounds wimpy and unprofessional, I'll take that. I never
chose this work to make a large amount of money, and for most of us who do
not work affiliated with hospitals, agencies or offices, our yearly intake,
considering the "women-hours" we put into it, seems quite low, and yet we
continued. It does seem that for better or worse, the era of the solo
practitioner may be coming to an end. To be in network with insurance
companies seems like we need to band together, both to be able to fulfill the
obligations of the companies themselves ( Aetna's webinar stated that patients
would be expected to be seen within 24 hours, not sure how any doctor could
do that...), and to allow participating IBCLCs to be salaried somehow, to
withstand the vagaries of reimbursement issues, and to have included
professionals dedicated to the critical work of just doing insurance and billing
tasks. I may lack vision, but I can't see how most of us who are solo
practitioners in full-time practice, without other work like agency, office,
hospital, or paid speaking or teaching work, could do this alone. I am
interested in what others are thinking during this time of change. I so want
mothers to all have access to the lactation support they and they babies need,
but I see how things are already being delayed as moms make multiple phone
calls to their insurers, and IBCLCs would have to somehow make sure they would
be reimbursed for their work, before ever setting foot in the home of a
crying, underfed baby and his frustrated, in-pain mom. This work is, in my
opinion, very different than other health care work. We are almost doing
"emergency" or crisis intervention work more than anything else. Timing is
critical. Waiting to make sure that the work will be fairly compensated ( if
that is even possible at current insurance company rates,) seems to not fit
with this kind of work at all. Which means, I suppose, that our profession,
what we can offer families and how we offer it, may have to change
radically. I do wonder what the future holds.
Peace,
Judy * I have been informed that in some states, my husband's profession
IS a licensed one, but overall the profession has given up on licensing for
all states, because it actually has not made things any easier in the
licensed states either.
Judy LeVan Fram, PT, IBCLC, LLLL
Brooklyn, NY, USA
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