Phew.  Just read through all the excellent letters, and responses,
questioning and explaining the new regulations and rules triggered by the
Affordable Care Act, and the IBCLC role in providing preventive health care
services to mothers and babies.

Please step back for a second, and recognize that ACA is not just about
IBCLCs and what we get paid.  It is about humongous, massive, tectonic
plate shifts in the rules, primarily for insurance companies and employers,
for covering all sorts of health care.  The entire machinery of healthcare
provision and reimbursement has been at a standstill for MONTHS, until the
U. S. Supreme Court decision could be announced.  Now that we know the law
is constitutional, ALL the regulation-writing and rule-making and
figuring-out-how-it-works-for-me thinking that has been delayed for six
months is now going on full-tilt-boogey.  And everyone is freaking out
about what all of it means, not just IBCLCs.

I have been telling IBCLCs the past few days (and I mostly "hang" with
private practitioners): Be careful what you wish for, and don't whine when
you get it.  IBCLCs have been clamoring for years that mothers should have
their visits with IBCLCs covered.  Well, now they are (or can be).  And
please recall the hand-wringing and angst that has been going on recently
by IBCLCs, worried that the not-so-much-IBCLCers are taking their jobs and
undermining their role.  Well:  at least one insurance company in the USA
now agrees with us: only IBCLCs should be reimbursed for providing allied
healthcare for lactation support.

I currently charge $175/visit in the Philly suburbs for my fee-for-service
home visit clients. I think I am a pretty good clinician.  I also plan to
sign up with Aetna, which has said it will only pay **IBCLCS** for
providing BF care to mothers with their insurance.  I feel rather strongly
about that part, thank you very much.  I will be interested to see how many
new clients call me from the Aetna network.  I will also be interested to
see if I consult with moms with fair-to-middling issues -- rather than the
train wrecks I customarily get as a private practitioner.  If mothers know
this service comes under their insurance, at no out-of-pocket to them, I
think they will call and make appointments.  I, for one, would LOVE to have
more of those fairly easy "breastfeeding check-ups," rather than the
full-on lactation-crisis-and-detective work cases that seem to dominate my
time now.
-- 
Liz Brooks JD IBCLC FILCA
Wyndmoor, PA, USA

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