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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