Hello Wise Ones,
 
Well, it's started. I am now getting calls from moms looking for lactation  
consultants in network, but their insurance company cannot provide them 
with any  names actually in their network. The mom also said that the insurance 
 company told her all lactation consultants are nurses, so she should get  
the lactation consultant to bill as a nurse doing a post-partum visit, 
and/or  many are working in pediatric offices so they can get a private 
consultation in  their pediatrician's office and that would be covered. As I am not a 
nurse, and  do not work for a pediatrician, the mom chose not to make an 
appointment with  me. As I watch the company my husband, with his other allied 
healthcare  professionals, has worked for go down under the burden of 
excessive  paperwork and denied, delayed, taken back, and lowered reimbursement, 
I see a  hard road ahead for new moms and "old" solo lactation consultants. 
As a company  of certified ( not licensed*, though) professionals, they were 
always reimbursed  for appropriate services by insurance companies, as well 
as Medicare and  Medicaid. They have an entire department of specialists 
which had to be put into  place to deal with the onerous and ever-changing 
rules governing reimbursement.  Everyone is salaried, so a slow week or month 
or three months did not mean  no one eats or pays bills. As a private solo 
practitioner, my work has been a  labor of love for the importance of healthy 
breastfeeding relationships and the  emergence of love and connectedness in 
families. If this sounds wimpy and  unprofessional, I'll take that. I never 
chose this work to make a large amount  of money, and for most of us who do 
not work affiliated with hospitals, agencies  or offices, our yearly intake, 
considering the "women-hours" we put  into it, seems quite low, and yet we 
continued. It  does seem  that for better or worse,  the era of the solo 
practitioner may be coming  to an end. To be in network with insurance 
companies seems like we need to band  together, both to be able to fulfill the 
obligations of the companies themselves  ( Aetna's webinar stated that patients 
would be expected to be seen within  24 hours, not sure how any doctor could 
do that...), and to allow participating  IBCLCs to be salaried somehow, to 
withstand the vagaries of reimbursement  issues, and to have included 
professionals dedicated to the critical work of  just doing insurance and billing 
tasks. I may lack vision, but I can't see how  most of us who are solo 
practitioners in full-time practice, without other work  like agency, office, 
hospital, or paid speaking or teaching work, could do this  alone. I am 
interested in what others are thinking during this time of change. I  so want 
mothers to all have access to the lactation support they and they babies  need, 
but I see how things are already being delayed as moms make multiple phone  
calls to their insurers, and IBCLCs would have to somehow make sure they would 
 be reimbursed for their work, before ever setting foot in the home of a 
crying,  underfed baby and his frustrated, in-pain mom. This work is, in my 
opinion, very  different than other health care work. We are almost doing 
"emergency" or crisis  intervention work more than anything else. Timing is 
critical. Waiting to make  sure that the work will be fairly compensated ( if 
that is even possible at  current insurance company rates,) seems to not fit 
with this kind of  work at all. Which means, I suppose, that our profession, 
what we can  offer families and how we offer it, may have to change  
radically. I do wonder what the future holds.
 
Peace,
Judy  * I have been informed that in some states, my husband's  profession 
IS a licensed one, but overall the profession has given up on  licensing for 
all states, because it actually has not made things any easier in  the 
licensed states either. 
 
 
Judy LeVan  Fram, PT, IBCLC, LLLL
Brooklyn, NY,  USA
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