In a message dated 3/13/99 8:27:44 AM Central Standard Time,
[log in to unmask] writes:

<<
 Proposed Bill:
 To provide health benefit plan coverage for the services of a
 lactation consultant.

 1) Lactation consultant means a person who is certified by the
 International Board of Lactation Consultant Examiners (IBLCE).

 2) This bill would require lactation consultant reimbursement by any
 health benefit plan that provides maternity benefits, including
 benefits for childbirth, when requested by the enrollee during
 pregnancy and for one year after the date of delivery of the
 enrollee's child. >>
Just a few comments from yours truly, and dh, this might mean needing a
detailed letter of medical necessity, and a prescription from an MD in the
plan( primary care MD, you know, who must be willing to acknowledge that the
mom and/or baby NEED an LC, and then talk to the LC about WHAT their
prescription should be, and wait until the MD or staff writes out the
prescription, or at least gives a verbal OK over the phone after speaking to
you, if you have a relationship with the MD and know they will follow through
with the written prescription and letter of medical necessity...) and then
waiting for authorization to be able to proceed and get coverage, otherwise
the LC takes the client, does the work (when it's needed, which is often
"right now"), and takes the risk. Once people expect their insurance company
to cover, they might not be willing to pay up front, then the LC is left
waiting for authorization( making the mom and baby wait as well) OR doing the
work, and then waiting and battling the insurance companies for payment at a
later date, which they may deny based on the date of service preceding the
date of authorization.  LCs will also need detailed fee schedules which
insurance companies have to approve. Insurance companies can insist on setting
fees and can deny payment over and above whatever fee they have set. The high
degree of independence in LC work will be lost. This has certainly been the
case in the professional world of prosthetics,  physical, and occupational
therapy , even where time is not so much of the essence to see a client. The
frustration can be incredible for the clients and the professionals. We may
need to be sure that any bill passed recognizes the unique and almost emergent
care style of Lactation Consultant work. I guess I sound like a nut here, but
these are things to consider as the LC profession moves into the mainstream of
health care -a place where we surely do belong, but which will not be without
a  price to pay in terms of the risks and benefits of putting ourselves "out
in the sunlight" where the insurance companies can both see and help LCs and
their clients, or burn us...
Judy LeVan Fram, Brooklyn, NY