Providing free outpatient lactation services through a hospital-base inpatient 
service is - - how can I say this - - so very brutal for any private practice LC 
in the community, and damaging to the profession as a whole.  

How many private practice physical therapists could make a go of it if their 
inpatient colleagues were offering free outpatient physical therapy?  
 
Unlike pediatricians who can establish a professional relationship with a patient 
from birth to age 18, lactation consulting is such a narrow specialty, serving 
mothers and babies during a very brief time of their lives.  

Occupational therapists are not educated and trained in lactation management 
and therefore cannot give skilled care for the motor learning needed by the  
breastfeeding dyad.  

Physical therapists are not educated and trained in lactation management and 
therefore cannot give skilled care for wounds that need to be healed, all while 
the body part is being used during the healing process re: nipple wounds, 
clogged ducts, mastitis, abscess, etc. or during the baby's healing re: CLP 
surgery and management before and after such surgery, or helping a Down 
Syndrome baby with poor muscle tone and the associated feeding challenges 
that can arise, and so on.  Skilled lactation clinicians provide tremendous help 
to mothers and babies and therefore to the entire family.     

Because a number of insurers ARE reimbursing to a certain extent for lactation 
services, I strongly believe that any inpatient or outpatient lactation service 
should be billing for services - - even if payment by the family must be made 
at the time of the visit (or we would not be able to continue providing 
lactation care) - - or at the very least, providing a superbill claim form to the 
family with every visit.  Advanced practice nurse and IBCLC Carol Chamblin of 
Illinois has information on her website about having hired a person to file 
patient claims for her, stating that she has found that reimbursement to 
families for her services has improved since her practice began filing claims 
claims for patients (rather than simply providing a claim form to a family and 
letting them pursue reimbursement with their insurer, should sleep-deprived 
new parents remember to do this, or remember where they have put the form 
upon returning home from the hospital, etc.).  Chamblin's CV posted on her 
website lists her work with ILCA on reimbursement issues.  On her insurance 
reimbursement page she states,

"I hope I have educated you with some new information here so as to guide 
you in making an informed choice surrounding your breastfeeding experience. I 
cannot guarantee insurance reimbursement, but I can promise you that more 
coverage is available than most people think."  Here's the link to the insurance 
reimbursement section of her web page:  

http://www. breastbabyproducts.com/insurancereimbursement.html

It's a quandary to want so very much to help mothers & babies & childbearing 
families and to believe to one's core that every family should have access to 
any and all such care as needed, regardless of the ability to pay, while 
needing to make a living in the profession of one's choice/one's calling.  It's 
my experience that those few families who can somehow afford the services 
of a private practice lactation consultant will almost always seek out the initial 
consultation but rarely a recommended and much needed follow-up 
consultation.  I like Chamblin's reference on her website that most 
breastfeeding concerns are resolved within one to 3 consultations.  

How many occupational therapists or physical therapists can say that about 
the health problems they address?  In my own personal health care in the 
fairly recent past, physicians have prescribed physical therapy in sessions of 
10.  

So give compassionate care, make arrangements for payment with families as 
you choose, and write off the charges as a philanthropic gesture as you 
choose.  But in the meantime, please, please provide the insurance claim form 
for your services for the family to file or do the filing yourself.  By doing so, as 
opposed to just giving free outpatient services when there are private 
practice folks in town who are - - believe me - - struggling to keep going - - 
you will be supporting your profession as one that is worthy of reimbursement -
 - as a health care profession with science behind one's practice.

Debra Swank, RN IBCLC
Ashburn, Virginia USA    

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