Jane states: " Here is the reimbursement rate I have seen: for Medicaid"

Reply: NONE of this discussion applies to Medicaid because IBCLCs are not
licensed and cannot be reimbursed by Medicaid. Aetna will not be providing
Medicaid coverage of lactation services.

Marias has brought up numerous concerns in her recent posts which I will
address in order below.

1. Maria states: "if insurance companies are planning to pay a third of what
we would charge" and "the only IBCLCs who will be able to afford to practice
will be those who are doing it as a sort of charity work"

Reply: The vast majority of IBCLCs charge significantly less than the fee of
$300 per visit that Maria refers to.

2. Maria states: "The good IBCLCs will continue to charge their rates out of
network, but they will have less business and fewer people will be helped."

Reply: This is a broad assumption. In looking at the health care model in
the US, I do not see this occurring among all other types of health care
practitioners.

2. Maria states: "As a policy matter, we should do what dentists have done,
that is, stay out of network until insurance companies pay what we deserve."

Reply: This is the opposite of what the USLCA Licensure and Reimbursement
Committee has been working for over the past 6 years. IBCLC want to be
integrated into the US Health Care system in order to be recognized as
legitimate providers and allow access to care for all families.

3. Maria states: "I was reading on a website for promoting breastfeeding in
pediatricians' offices that a pediatrician can bill a visit re lactation as
a regular visit!  Now, the amount a physician would receive for a 15 minute
visit (which visit would not give the mother the thorough lactation help
that she needed) would be more than an IBCLC would make at a 2 hour home
visit that included an hour of travel round-trip!"

Reply: This is not true. The highest coded physician visit for a new or
established patient reimburses roughly $50 less than the highest preventive
counseling code (99404) that we reviewed.

4. Maria states: "Sadly, it seems that there were real problems with the
survey. Perhaps these numbers were somehow derived from a hospital LC's
salary."

Reply: This is not true. The surveys included responses from IBCLCs in all
settings, full-time and part-time, and from all over the country. Those
working in public health actually were paid generally lower than the norm.
There were a few in office settings that were paid more.  The USLCA survey
had 761 respondents. The IBLCE survey went to over 10,000 IBCLCs and had a
29% response rate, to include 2500 IBCLCs.


5. Maria states: "The calculations may seem like a great place for the
insurance companies to negotiate down from."

Reply: These codes and the fees associated with them are existing, they are
note created new just for IBCLCs. All types of other health care
professionals use these codes accept these rates of reimbursement for their
services.

6. Maria states: "Honestly, a lactation consultant should be charging for
her specialized services on par with what a physician would charge for a
home visit." Maria suggests $300 for these visits.


Reply: In researching the CMS physician fee schedule, the national rate for
a physician highest level home visit, that would coincide with the lengthy
lactation consultant home visit- code 99350 - the reimbursement rate is
$185.28. We are currently working with Aetna to determine whether home visit
codes will be covered. If so, they will be somewhat higher than the office
visit codes, but not likely $300.
Additionally, with regard to other home visiting professionals with whom I
personally work such as Occupational Terapists, Physical Terapists and
Speech therapists, the reimbursement rates for visits is in the $40-60 per
hour for 1-2 hours visits, face-to-face time in the home, without offsite
documentation or business expenses covered separately. These visits
frequently involve 1-2 hours of travel time and tolls or parking fees as
well.
Maria is asking to be paid more than any other kind of health professional.


7. Maria states: "Home visits provide a unique opportunity for mothers to
receive help nursing in different positions and even having weighed feeds in
different positions."

Reply: This can certainly be done, and is done, in office settings as well.



8. Maria states: "Sadly, mothers will see that Aetna sanctions this practice
and will choose to use an in network provider who lives in another state (or
country?!)"

Reply: This accusation has no founding, it is not the thought or intention
of Aetna or USLCA to provide families with poor care. It is a model being
used by other professionals and insurers, and by Aetna in other areas, to
try to provide services to families when no other option exists.


9. Maria states: "Too bad that Aetna fooled them [USLCA] into thinking that
breastfeeding is something that can be shown with a doll over Skype and that
a lactation consultant does't need to check the baby's palate or tongue or
suck or anything else."

Reply: This is also a false accusation. This was not Aetna's suggestion at
all. In fact, I gave it as an example because some lactation consultants in
the US are using Skype to provide consultations. I did qualify that
statement by saying "this is not ideal" - but at times this will be the only
option for helping a mother and I believe it is better than no help at all.

10. Maria states: "It is becoming more clear that Aetna is not really
worried about helping 'women who cannot otherwise afford a lactation
consultant.' "

Reply: This is another unfounded accusation. In our dealings with Aetna,
there are many departments who have been working on making lactation
services available to mothers in compliance with the ACA laws. There has
been no evidence at all that they are trying to undermine breastfeeding by
providing poor services. In fact, in the multiple meetings that have
occurred I have observed nothing but willingness to learn about lactation
consultants and the services we provide and cooperation to meet our needs.


11. Maria states: As for insurance companies not being able to pay for
travel time--it really irks me to hear flat out statements such as this from
insurance companies.

Reply: This statement is taken out of context. It did not say anything about
what insurance companies can 'afford'. It was stated that health insurance
does not pay for transportation. Insurance does not cover the cost of
patients going to hospitals or offices, nor does it cover costs of providers
going to patient homes. It is not the purpose of medical insurance.


Judith L. Gutowski, BA, IBCLC, RLC

 


             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome