Susan writes:
I'm afraid that so far, the PRIVATE PRACTICE IBCLCs in Manhattan are not
enthused and quite fearful of becoming providers for Aetna. "
~~~
Hello all,
First, thank you to Susan for so eloquently representing my thoughts on
this issue.
I am a direct witness to how this has affected the company my husband
works for. Increasing procedures and paperwork demands and decreasing
reimbursement rates ( including being reimbursed a few dollars for thousands of
dollars in custom prostheses and patient care time), as well as having money
taken BACK if paperwork or procdures change, as they do constantly, and
complete denial of payment for any small difference between one document or
another, are killing off many prosthetic professional services, except for
the "Wal-Mart" type companies who survive on high volume and low direct and
caring patient care. Not to be funny, but this company has been limping
along for years, recently suffering the letting go of some professionals, and
the significant salary cuts of those ( like my husband and his partner)
who remain. They cannot pay monthly bills, often cannot order the things they
need to make the prosthetics in a timely fashion, and spend hours and
hours doing paperwork. In their profession if the doctor of the client writes
something even subtly different from the prosthetist, the doctor still gets
paid but the prosthetist does not. I cannot imagine having to get a doctor
to note that a baby is tongue-tied, has reflux, and write in the exact way
I do, or something else I see at a visit which they either don't see as
real or don't accept as relevant, to get paid. The idea of moms not having to
pay out of pocket for a consultation is a great goal, but the execution
appears fraught with problems for private practice IBCLCs. In the end, the
insurance companies executives will still continue to get richer, and many
"small" but necessary healthcare providers will be literally unable to
provide for themselves and their families.
Peace,
Judy
Judy LeVan Fram, PT, IBCLC, LLLL
Brooklyn, NY, USA
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