For the past 2 years in private practice I have been reimbursed by HMOs as an out-of-network provider, without a contract.  Suddenly, without notice one of them is only covering hospital-based services (which excludes me), and 2 others are leaving the state.  A third company has told me all along that they do not cover lactation services (of course the MD who saw me managed to get 100% reimbursement, and a few other fighters obtained 50%), but I just found out that they are covering....for hospital based services.  When I call for an application or contract I get all kinds of run-arounds.  What is happening with insurance reimbursement for other private practice LCs and are there legal issues (anti-trust, or ...)?  Thanks for your responses.  Bettina Pearson

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