Dear Judy and Marsha:

I'm afraid that so far, the PRIVATE PRACTICE IBCLCs in Manhattan are not enthused and quite fearful of becoming providers for Aetna.  One of our IBCLCs has managed to figure out how to get about 95% reimbursement without being on provider panels.  

In Manhattan I know of no IBCLC who is making tons of money and many very competent IBCLCs who are struggling to make an adequate income when they are relying predominantly on their income as an IBCLC.  The average rate for a home visit is $250 per VISIT and a visit usually lasts between 90 minutes and 3 hours for most IBCLCs I know.  Transporation time is about 1-2 hours for each and every client seen.  

On another discussion forum Judy mentioned that Aetna will reimburse at less than half of what an IBCLC in Manhattan would make and that the time of a visit is considered to be 60 minutes.  Personally, I do not see how anyone can competently and thoroughly assess an mother baby infant in a mere 60 minutes, let alone including transportation time. 

If Aetna manages to get IBCLCs to be on their provider panels it is likely to be those who practice infrequently.  I know some hospital IBCLCs who dabble in seeing clients on the side who might be able to afford putting themselves on a provider panel.  While there are some terrific hospital IBCLCs who practice privately, I also have had to follow up after SOME hospital IBCLCs who really have minimal experience with older babies and do not even provide insurance forms, care plans or receipts.  So, what I think will happen is that those who dabble to augment their income in the hospital and those who dabble because this is a hobby and not a profession will be the ones who can afford to be on the provider panels.  They will then outcompete those who really rely on the IBCLC as a profession and for our income. The quality of care will also drop.  

Those who cannot afford to be reimbursed at such a low rate.  If I take my best year as an example -- my grosss income would be less than $48,000 a year, my expenses are around $3,000 a year when I'm not purchasing equipment, our health insurance rates are $20,000 a year and we pay our taxes at well above the rates of Romni and Obama. So the net income would be below the poverty level.

I actually do NOT see that this will increase clients for me because I see as many as I can and it is not lack of insurance that preventing me from seeing more.  Often it is poor quality care from other people who take short courses and dabble in lactation that keep me from seeing more.  

Please provide some guidance into how you think the New York Lactation Consultant Association might turn this from a lose (moms losing good quality care) - lose (the ability to earn a decent living situation) into some sort of compromise that might keep us from having to abandon our profession.

Sincerely, 

Susan E. Burger, MHS, PhD, IBCLC
Secretary Treasurer (former Pres) NYLCA

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