Judy writes:

> this might mean needing a
> detailed letter of medical necessity, and a prescription from an MD in the
> plan( primary care MD, you know, who must be willing to acknowledge that the
> mom and/or baby NEED an LC, and then talk to the LC about WHAT their
> prescription should be, and wait until the MD or staff writes out the
> prescription, or at least gives a verbal OK over the phone after speaking to
> you, if you have a relationship with the MD and know they will follow
> through
> with the written prescription and letter of medical necessity...) and then
> waiting for authorization to be able to proceed and get coverage, otherwise
> the LC takes the client, does the work (when it's needed, which is often
> "right now"), and takes the risk. Once people expect their insurance company
> to cover, they might not be willing to pay up front, then the LC is left
> waiting for authorization( making the mom and baby wait as well) OR doing
> the
> work, and then waiting and battling the insurance companies for payment at a
> later date, which they may deny based on the date of service preceding the
> date of authorization.
>

Judy,
This is what it is like NOW. :-D

At this time, the bill reads that mothers (enrollees) may self refer.
This may need to be revised before it gets through committees and
hearings, but this is how it is written initially.

We'll see what changes may come.  We may get more than we hoped for.
--
Jeanne Mitchell, Austin, TX
http://www.flash.net/~xanth/home.htm
mailto:[log in to unmask]
"You can tell the quality of a person by how
they treat people they don't need." My Dad