I am a member of the Third Party Reimbursement Committe for USLCA. The
chair of the committe is Carol Chamblin of Illinois. She would like to
respond to Pam's post and is not on Lactnet currently, so I am sending on
her comments. Please respond to her directly as well as to the list.
Thank you,
Pat Bucknell IBCLC
Avon Lake OH
From: Breast N Baby Lactation Chamblin [log in to unmask]
Dear Pam,
You bring up some legitimate concerns regarding licensure and
reimbursement. I will leave the licensure topic alone, but want to make
a brief notation about reimbursement. I agree with you that there are
not only limitations when it comes to reimbursement, but darn ole'
headaches and heartaches! I wish I could practice without it. It would
make my job a lot less stressful, and I'd have less pay out to my biller
for her services. However, I think other health care providers wish they
didn't have to deal with the insurance industry, but it's just a reality.
Without insurance coverage, I would not make the same choices to seek
medical care as I do now with partial coverage. For example, I'd
probably not have my annual mammograms without coverage because the cost
would outweigh my present risk. I might decide to have my mammogram
every 2-3 years instead of annually.
We are hearing about hospital-based positions being eliminated throughout
the U.S. Those in private practice are struggling to make a living.
Indeed, the survival of our profession is at risk. I feel strongly that
one way to counter these financial problems is to seek reimbursement.
Personally I have found that I can make a living in the field of
lactation as a result of reimbursement. It allows me to make an impact
on the clinical outcomes of breastfeeding-related health matters.
Individuals and institutions/offices/depts. can decide for themselves
whether or not to take the challenge of insurance reimbursement. It
doesn't have to be mandated. For instance, a medical doctor could
practice without accepting any insurance plans. It's not mandatory.
What do you think his/her patient load would be like compared to "Dr.
Smith's" who accepts major health care plans? I'd choose to go to the
doctor within my health care plan rather than to pay-out-pocket most of
the time.
Another benefit of doing reimbursement is the listings on the websites as
in-network providers. Many times women whom I serve tell me that they
found their OB/GYN by browsing the name list in their provider booklet.
Often times patients find me via the same routes. So far, I feel the
benefits outweigh the hindrances for my practice. It is my personal
choice, and it is my goal to educate others to do reimbursement if they
so choose to promote the recognition we deserve for our profession.
And, you mention the importance of establishing standards of care.
Please volunteer to join a task force when the time comes. There will
always be differing opinions amongst health care providers. The medical
model consists of this same problem. There are different ways to
approach the treatment plan of a newly diagnosed asthmatic. However, the
professional standards featured by the lung association are still present
to the public to aid in consistency of care. The awareness that asthma
has a standard treatment causes us to not be accepting of treatment
consisting of "just keep trying to breathe" when someone enters an
emergency dept. with difficulty breathing.
We need to establish standards of care within lactation to rid of the
mismanagment of breastfeeding mothers and babies who are presently
treated with the words "just keep trying to breastfeed".......
Carol Chamblin RN, APN, IBCLC
USLCA BOD - Reimbursement
St. Charles, IL
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