As a private practitioner in Vermont, my partner and I had to stop billing
insurance and seeking insurance reimbursement. The tactics Jean talked
about, ie "foot dragging," and "lost claims," often meant that we had
accounts receivable for a year or more, and no matter how many times the
claims were resubmitted, they still went into an abyss with no payment
forthcoming. It was a nightmare.  We simply could not afford to play those
games.

We now solely take payment up front, giving a superbill for receipt for the
client to submit. It is a lot easier to diss a business/private IBCLC than
it is to diss the person whose paying you (but they manage to do it)...and
we have a sliding scale, and will even take barter for services, so we
never turn someone away who needs help based on ability to pay.

I had the unique experience the other day of talking to an insurance
company about a client of mine. They wanted to know more details about my
services, and as a nurse and an IBCLC, I was glad to share that in order to
help my client get reimbursement.  The mother, briefly, had a long history
of breast infection, abscesses, etc, and had been bottlefeeding EBM for 2
weeks before I saw her.

The nurse who reviewed claims asked what I could do for her, etc, and I
explained how reestablishing breastfeeding directly could help this mother
heal her abscesses, as it would provide better emptying, and avoid further
surgical drainage (she had had 3 drainings of the abscesses, youch!).  I
also told her that with the cost of formula, the mother could not afford
NOT to breastfeed (the mother told me this herself).

The nurse reviewer's comment to me was "If she cannot even afford formula,
why is she paying for visits from YOU?" She was absolutely and horrifyingly
ignorant about breastfeeding.

After I took a deep breath, wondered why I wasn't in a different job like
checking groceries, and wishing that all  Managed Care companies would
disappear, leaving those of us behind to take care of clients with
knowledge and attention, I hung up.

The nurse reviewer made the recommendation to the Medical Director, based
on our conversation, and the claims for IBCLC services were denied.

In the U.S., we need a HUGE insurance overhaul in order to revolutionize
patience care, and put the word back into it, ...ie C.A.R.E.

Kathleen

Kathleen B. Bruce, BSN, IBCLC co-owner Lactnet, Indep. Consultant
mailto:[log in to unmask]
http://homepages.together.net/~kbruce/kbblact.html
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