Last year at the ILCA convention in Las Vegas, there were several speakers with topics on reimbursement.   

Some points that I remember include the following thoughts.   

     The IBCLC who has an advanced practice degree will have improved reimbursement.  

     Hospitals can educate and also negotiate with their insurance providers to for lactation reimbursement.

     Insurance companies usually don't reimburse for education, but may for lactation problems.

 

Some of the same speakers are again speaking at this years ILCA convention.  Sincerely, Rachel Wahl RN IBCLC 
 
> 
 Date: Sat, 18 Apr 2009 17:40:32 -0400
 From: Debra Swank [log in to unmask]
 Subject: hospital lactation consultants and outpatient services
 
 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 lactction 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 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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