I am replying to Susan's post with comments right after each new paragraph.

Marsha Walker, RN, IBCLC
Weston, MA

I'm afraid that so far, the PRIVATE PRACTICE IBCLCs in Manhattan are not
enthused and quite fearful of becoming providers for Aetna.  One of our
IBCLCs has managed to figure out how to get about 95% reimbursement without
being on provider panels.

" Susan, I cannot figure out why IBCLCs in Manhattan would be fearful of
being reimbursed by Aetna. IBCLCs are not required to join the provider
network, this is their choice. The person receiving 95% reimbursement is
fine for her, but many other IBCLCs in other parts of the country have not
found this same reimbursement rate. No one says that you have to give up
charging a fee for your services that you set. This does however impact
mothers who cannot afford to pay out of pocket to see private IBCLCs in
Manhattan. This creates a disparity and lack of access to IBCLCs in the
mothers who cannot afford to pay you. If these mothers cannot obtain the
level of care that they need they will simply wean babies onto formula.
IBCLCs can continue to see fee for service clients as well as accept
insurance reimbursement. The two can be done together."

In Manhattan I know of no IBCLC who is making tons of money and many very
competent IBCLCs who are struggling to make an adequate income when they
are relying predominantly on their income as an IBCLC.  The average rate
for a home visit is $250 per VISIT and a visit usually lasts between 90
minutes and 3 hours for most IBCLCs I know.  Transporation time is about
1-2 hours for each and every client seen.

"$250 is a lot of money for many mothers to have to pay for lactation
services. Some IBCLCs can and will continue to see mothers who pay upfront
as well as mothers with insurance coverage. What happens to the mothers who
cannot afford the $250? With insurance coverage, at least they then have an
opportunity to receive the same type of care that more wealthy clients
enjoy."

On another discussion forum Judy mentioned that Aetna will reimburse at
less than half of what an IBCLC in Manhattan would make and that the time
of a visit is considered to be 60 minutes.  Personally, I do not see how
anyone can competently and thoroughly assess an mother baby infant in a
mere 60 minutes, let alone including transportation time.

"Many of us have certainly had to learn how to provide care in short time
periods. You do not have to give up charging $250 to fee for service
clients. You can also see Aetna patients who have no other manner of
securing IBCLC services."

If Aetna manages to get IBCLCs to be on their provider panels it is likely
to be those who practice infrequently.  I know some hospital IBCLCs who
dabble in seeing clients on the side who might be able to afford putting
themselves on a provider panel.  While there are some terrific hospital
IBCLCs who practice privately, I also have had to follow up after SOME
hospital IBCLCs who really have minimal experience with older babies and do
not even provide insurance forms, care plans or receipts.  So, what I think
will happen is that those who dabble to augment their income in the
hospital and those who dabble because this is a hobby and not a profession
will be the ones who can afford to be on the provider panels.  They will
then outcompete those who really rely on the IBCLC as a profession and for
our income. The quality of care will also drop.

" I fail to see any relevance in this paragraph. You are making pretty
gross assumptions that have certainly not been shown anywhere to be true.
Based on the number of interested high power LCs that attended the
licensure and reimbursement special interest group at the ILCA conference,
I would have to disagree with your conclusions."

Those who cannot afford to be reimbursed at such a low rate.  If I take my
best year as an example -- my grosss income would be less than $48,000 a
year, my expenses are around $3,000 a year when I'm not purchasing
equipment, our health insurance rates are $20,000 a year and we pay our
taxes at well above the rates of Romni and Obama. So the net income would
be below the poverty level.

"You are making more assumptions here. These calculations are being made on
a theoretical practice that only received insurance reimbursement and did
not have any other fee for service clients. I would think that most
practices would be a combination of fee for service and insurance
reimbursement."

I actually do NOT see that this will increase clients for me because I see
as many as I can and it is not lack of insurance that preventing me from
seeing more.  Often it is poor quality care from other people who take
short courses and dabble in lactation that keep me from seeing more.

" You are basing assumptions on your own practice. We have many IBCLCs who
would benefit greatly from reimbursements under $250. Your practice may be
full but that does not mean that other IBCLCs can't still take more
clients."

Please provide some guidance into how you think the New York Lactation
Consultant Association might turn this from a lose (moms losing good
quality care) - lose (the ability to earn a decent living situation) into
some sort of compromise that might keep us from having to abandon our
profession.

"Why would you think we have to abandon our profession if we take Aetna
covered clients. I think you are exaggerating here! Mothers and babies are
the real losers if we refuse to see them unless they can pay up front. You
are not obligated to become an Aetna provider, but others may wish to do so
and they certainly can without abandoning their profession."

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