Jaye states: "So why can't we do what my Dentist does?  He charges $X for a
service.  The patient knows they are financially responsible for that
service and pays for that service in full.  Dr. sends a claim to the
insurance company who reimburses him $Y amount.  Then Dr. reimburses the
patient $Z:  $X - $Y = $Z In this manner, the patient gets proper care
without paying the full price, the Dr. gets to treat patient and does get
his full price." 

 

Reply: The Affordable Care Act has required Preventive Health Services to be
covered with NO COST SHARING to the patient. This is the law. No additional
funds can be collected except what the insurance reimburses. You either
accept their rate or the client must self pay without insurance coverage.  

 

Jaye states: "I read 'preventative counseling' as a pro-active session
designed to provide information and some basic problem-solving strategies.
... What I do, and what many IBCLCs do is more like 'crisis intervention'
The phrase 'preventative counseling' seems to  have little to do with how
most private practice IBCLCs work."

 

Reply: The term "Preventive Counseling" is not being used in the way you
discuss. It means that BREASTFEEDING is a Primary Preventive Health
strategy. Breastfeeding improves the ultimate health of the mother and
infant and reduces life-long health care costs. It does not mean our
services are preventing a breastfeeding problem from happening. 

 

Jaye states: "I do find it disconcerting that a physician can bill for a 15
minute lactation visit in office and get paid more than a 2 hour home visit
by someone who is providing a vastly different level of detailed analysis,
individual relevance in one's own home, the ability t0 take time to see the
effect/outcome of many of the suggestions and strategies and  much  deeper
and broader follow-up care."

 

Reply: The usual physician codes 99201-99203, and 99211-99214 are also
approved for IBCLCs to use if they choose to do so. I did not share any
information about those codes yet, only one single code because it is likely
to be the most useful. The 992xx codes all result in lower reimbursement,
(this is $10 less if the physician provides the highest level complex visit
and $80 if billing for a simple visit)than the 99404 preventive counseling
60 minute code that I gave as an example.  

 

All of this discussion is based on assumptions without complete information.
If IBCLCs will participate in the upcoming webinars, you will be given
information that debunks many of these assumptions.  

 

The comparisons and physicians also do not consider that physicians have
expenses far and above those that IBCLCs and increased contract requirements
from insurers. Requirements include things such as these just to name a few
off the top of my head: the significant cost of their initial education, the
much higher cost of liability insurance, the stipulation of having other
staff attending patients "at all times" when they are performing office
visits, and 24 hour call coverage at all times. 

 

 

Judy

Judith L. Gutowski, BA, IBCLC, RLC

135 McGrath Lane

P Box 1

Hannastown, PA 15635-0001

Cell Phone 724-331-6607

Fax 724-837-0129

 


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