I've used many different ways...in my agency in St. Louis, they had an
"official" sliding scale - that is, they asked for information on income
and billed accordingly - from $5 to $35 for 30 minute visit.
I find that's very difficult, as newly delivered moms and their families
are facing extra expenses that may not be usual and customary. I like the
ideas mentioned by others about accepting "trade" or dividing the payments
by 2 - 3 months.
In Proyecto Lacta in Puerto Rico, we told everyone the value of the visit
was $50, and they should pay what they can, realizing that those moms who
paid the cost were helping out those mothers that could not pay. This
meant some moms paid 50 cents - and some paid $100 to help other moms. As
we also had a Federal grant and assistance from the hospital where we were
housed (no rent, no utilities), we were able to manage...but we DID have to
charge for pumps and other equipment, as we rented them.
Here in the California county I live, we have private lactation consultants
who see moms for payment, and they refer those who cannot pay to La Leche
League or to the county Health Department. The Health Department offers
services through WIC, Public Health Nursing and the Bureau of Maternal and
Child Health, (which employs me). We also collaborate with other agencies
that are part of the "Comprehensive Perinatal Services Program" (CPSP).
Moms who have Medicaid (Medi-Cal in California) can receive services
through CPSP for at least 60 days postpartum - that are paid for by
Medi-Cal. Breast pumps are paid for if there is a medical necessity (baby
not able to latch on is considered a medical necessity - it doesn't have to
be a baby in NICU). WIC has pumps for moms that do not fit into some of
the MediCal categories.
It's a very awkward system, and we'd like to improve on it as every time an
MD or an RN sees a mom having difficulty they have to ask questions about
their insurance coverage and income in order to refer them appropriately -
otherwise the mom gets one number, may then be told to call another and may
be lost in the shuffle. However, we are very proud of the collaboration
among all the different groups and agencies. It isn't perfect, but at
least we're trying - and working together to improve it through the
Breastfeeding Task Force.
Ideally (we're trying to convince the - $$ - powers that be - $$ - ) every
mom would get a home visit on day 3 - 4 postpartum - depending on their
discharge day (shades of the Heinig and Dewey study in Davis, CA) with
additional visits as needed. THEN we could hire or contract with IBCLCs to
make these visits and provide appropriate help without worrying about who
has what insurance!
I understand some other counties California already have done this.
Jeanette Panchula, BSW, RN, PHN, IBCLC
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