Melissa brought up some important points in her posting regarding insurance
reimbursement for lactation care and services. The IBCLC credential is
becoming the recognized certification for reimbursement. There is an HMO in
Massachusetts that reimburses for one LC visit in the hospital and up to $150
of LC services post discharge. The criteria for reimbursement is that the
person is IBCLC. This means that it is important to acquire and maintain the
credential.

Next to consider is to become a preferred provider with insurance carriers.
Is this what you are trying to do? If you need to be certified by the state,
consider having them check the IBLCE registry to validate that your partner
is an IBCLC. Louisiana is the only state I know of that has a state registry
of IBCLCs for insurance carriers and employers to access. If you are not an
IBCLC it is unlikely that your services would be reimbursed.

Check into the exact wording of the bill that you think has passed in the
state to see what is actually covered. It depends on the type of insurance
that your clients have as to whether this legislative bill covers them. If
your clients self pay and they are entitled to reimbursement from their
insurer and are being denied this, have them fill out the complaint form from
the state insurance commission and send it to the state insurance
commissioner detailing the problem.

Watch for an article in the next ILCA Globe that is a reprint of information
from a newsletter called Pediatric Coding Alert.

Marsha Walker, RN, IBCLC
Weston, MA

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