Thank you. I was trying to figure out how to say much of the same.
We HAVE to be able to voice our concerns and frustrations without labeling it as an attack, and we have to be able to listen to everybody.
I am very interested in all of this because it affects my profession. We have got to get this right.
Melissa Senf, IBCLC, RN, LLLL
-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Maria Paciullo
Sent: Wednesday, August 01, 2012 2:15 PM
To: [log in to unmask]
Subject: insurance reimbursement
It must feel like a personal attack when so many volunteer hours have been donated to achieve reimbursement results. It is really important to know that no one who is speaking up about the inadequacy of the rates is personally attacking those who worked hard on this project and no one is unappreciative.
The facts remains that we are not represented by an attorney. To answer your question, no I was not a member for the past six years, as I took the exam yesterday. As an attorney and as a business person, I am yelling, DANGER and PLEASE STOP! These matters are NEVER to be negotiated by anyone except an attorney who does this on an everyday basis. For all of the wonderful IBCLC's who have written in to say that they are happy with the rates, please know that your best interests are not being served by not having someone advocate for you. Rest assured that the way that these numbers were calculated were based on a framework that was set by Aetna. I am a highly skilled negotiator and have represented large companies I have also been privy to the inner working of insurance reimbursement. AND I WOULD NOT TAKE THIS ON!!!! Yes, I am a wise business person, yes I am extremely experienced, but the ONLY people who should be doing this are people who deal regularly with negotiating reimbursement rates with insurance companies. Every other professional organization uses appropriate attorneys and we must do that now! Let's not attack each other, let's figure out how to do this TODAY! We appreciate the people who have been working on this. THANK YOU! Now why in the world have left these people to do it without proper representation!
By definition, if we have not hired these people, we have failed.
Instead of feeling the obligation to say thank you to those who have worked so hard for us, let's say thank you but we need to help you so that we can get this right.
To those who are happy with the rates, please do not criticize those who are speaking up and voicing their very legitimate concerns that the rates are not in their best interests. We are all a team here, and we need to make sure that everyone gets paid the most that she can so that our profession will survive and prosper--and that is the only way we will help mothers and babies in the end.
If you really care about mothers and babies, then let the insurance companies pay our rates so that mothers here will not have to pay out of pocket for our rates.
And please don't be dissuaded by any rephrasing of our comments--we never said that people who currently charge lower rates are lousy--we said that we feel that you should be paid more and are saints for doing your work. Down the road, though, Susan is right, there will be a few saints doing the work for cheap and the profession will either die out or allow for inadequate help to be provided to mothers. We are telling you that we cannot stay in business at our current rates, and the goal should not be to stay in business, it should number one to help mothers and babies and second to prosper at the same time. Are your physicians prospering while they help people? Of course! It is not their main goal, but they do deserve to be paid well.
As an aside, I would like to mention that when we consider business costs we should be considering --the cost of incorporating --the cost of marketing time --the cost of health insurance --the cost of disability insurance (several thousands of dollars per year) --the cost of office space, if used --the cost of a vehicle and wear and tear and gas --the cost of travel time --the cost of continuing education --the cost of equipment such as computers, scales, charting software --the cost of follow up time on the phone and via email --the cost of follow up time for contacting physicians, etc.
--our time with the mother
--liability and umbrella insurance
--the cost of childcare
--the cost of EDUCATION (now a requirement) --the cost of staying home and giving up an income while we developed the art of nursing--unique experience --the list goes on Now, don't think about the minimum you should be paid or even what you have been paid in the past! As time goes on, Insurance is going to have to reimburse in the future. Up until now we have been charging low prices because mothers have been paying out of pocket. That is called doing a percentage of each visit as charity work. No one should be doing charity work for an insurance company!!! You can and should be paid well for your time.
Regardless of the above notes, the point is that we MUST be represented appropriately. Every other professional organization uses appropriate attorneys and we must do that now! Let's not attack each other, let's figure out how to do this TODAY!
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