Thank you, Liz, for your expertise in these matters.

I think this insurance company was doing exactly what you said: deny, deny,
deny.  My client kept telling me there was yet another reason they denied
the claim.  She blamed me for the denial, and reversed her credit card
charges.  I almost took her to small claims court to get it back, but she
finally paid me.

Cover your ass, everyone!  Make sure they sign your forms.  Thanks to Pat
Lindsay for her forms.  I would never have thought about the level of
detail you need in the forms.

Julie Tardos



> ------------------------------
>
> Date:    Fri, 9 Aug 2019 06:43:32 -0400
> From:    Elizabeth Brooks <[log in to unmask]>
> Subject: Re: Diagnosis codes, legal for IBCLCs to use???
>
> Diagnosis codes on health insurance forms are there for purposes of
> establishing legitimate rights to receive payment.  They are not there to
> "establish" the medical diagnosis -- which, indeed, IBCLCs cannot provide.
>
> Insurance companies use lots of words that we use -- but it is part of
> their unique insurance lexicon.  One big company "certifies" IBCLCs to be
> part of their pool of approved caregivers.  What they mean by
> "certification" is a whole different kettle of fish that what IBLCE means
> by my "certification" to be an IBCLC.
>
> It is common in the USA for insurance companies to only reimburse care
> provided by (or at the direction of) a licensed healthcare providers.
> IBCLCs are thus "frozen out."
>
> It is common in the USA for insurance companies to deny deny deny
> legitimate payments, hoping to wear down individual and their healthcare
> providers. Me throwing in the towel on $50 that is not worth the *dozens*
> of hours it will take me to collect it only costs me $50.  But when the
> insurance companies do this hundreds of thousands of times a day, you can
> see why it is a profitable business model for THEM.
>
> The California-based parent and/or IBCLC should check out the CA
> Breastfeeding Coalition page for resources and support to fight this denial
> of coverage.  California often has protections under the law that are
> *better* than for other states, or the nation as a whole.
> http://californiabreastfeeding.org/breastfeedingrights/
>
> This is a lovely plain-English explanation of the whole sordid sorry
> insurance coverage mess we must deal with here in the USA:
>
> https://www.verywellhealth.com/learn-about-insurance-codes-to-avoid-billing-errors-1738628
>
>
> --
> Liz Brooks, JD, IBCLC, FILCA
> Wyndmoor, PA, USA
>
>
>

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