FROM: Sturgess, Frances Coulter
TO:[log in to unmask]
SUBJECT: insurance co. and brfdg support
DATE: 01-21-97   17:41 EST
PRIORITY:


question:  if brfdg is acknowledged to be best and cost effective (less med.
visits etc) how is it that ins. cos have not figured out that it should be in
their best interest to support it?

One theory is that like medical nutrition therapy, (ie from a Registered
Dietitian) it does not seem truly like a "medical procedure" and that if it
was, MDs would be doing it and they get reimbursed anyway so ...

Another theory is that it is part of normal hospital service and does not need
to be broken out as a reimbursable entity

Yet another theory (from a horse in the insurerers stable) is that since
hospitals and medical orgs get so much money from the ABM cos, nothing the ins
co could say re: "Do Baby Friendly or we won't ccontract with your hospital"
would have any impact on hospital practice (and they would get laughed out of
the negotiations)   This confuses me a bit--it sounds like the hosp needs the
ABM co more than it needs the insurance co, and that doesnt sound right to me
at all... unless the hosp is also saying they would pass the costs of
trainings, health ed materials, and any "needed"ABM on to the ins. co, thus
eating up the savings generated by brfdg support???????????

Any ideas on this last one, anybody?  Any strategies to disarm it?  Any notion
 of how to find out if it is true?