Dear Friends:
     I have bitten the bullet and sub-contracted to a group in order to get
LC work. Most people have  some form of BlueCross/BlueShield in my area and
won't pay out of pocket. BC/BS kicked the private practice LCs out of network
when the new HIPPA regulations went into effect, saying that there was no longer
a billing code for us.
     So my income is less, but 0% of a higher number is still zip. So my
private practice fees are a thing of the past. I am glad I can get work this way,
keep my skills up, and make some money.
     At orientation today, my preceptor told me that the basic mother-baby
visit is basically a loss-leader for the insurance companies, who want to
attract clients. That is why they reimburse so little for them, so the agency gets
little and the field nurse gets less. The money is in the technology:
wallabies, high-risk antenatal care, high risk infant care, and wound care. I was told
that certain visits were the good ones, because they were short and paid
relatively well.
     The implication to me seems that one must be efficient and not spend too
much time with a client in order to make a living.
     The lactation visits pay a little more than mother-baby, some acknowled
gement of higher training. I was cautioned not to do "too much breastfeeding
teaching" at a mother/baby visit, but to get authorization for a lactation
visit.
     This is modern public health nursing?
     Gag me with a spoon. I have decided, since I have some other sources of
income, to take one case a day and take my time.
     This is what is happening in the USA now.
     warmly,
Nikki Lee RN, MS, Mother of 2, IBCLC, CIMI, CCE, craniosacral therapy
Adjunct faculty, Union Institute and University, Maternal and Child Health:
Lactation Consulting
Supporting the WHO Code and the Mother Friendly Childbirth Initiative

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