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Subject:
From:
Maria Paciullo <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 31 Jul 2012 01:05:26 -0400
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text/plain
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Surely we all support the idea that every mother/baby dyad should receive good lactation support and have it paid for by her insurance company.  However, we also must recognize that if insurance companies are planning to pay a third of what we would charge, then these are the only things that could possibly happen, and none of them are good for mother/baby dyads:
1.  Mothers will start choosing to get help from IBCLC's who accept the low payments from insurance, and the only IBCLC's who will be able to afford to practice will be those who are doing it as a sort of charity work (in other words, they are relying on a husband's/partner's  income), and since in 2012 in NY we live in a world where women actually expect to get paid for their work and many need to feed their families, the rest of the IBCLC's will get other jobs and move on to other careers.  There will not be good help readily available for mothers and babies.  

2.  The good IBCLC's will continue to charge their rates out of network, but they will have less business and fewer people will be helped.  These good IBCLC's may or may not go out of business.  There will not be good help readily available for mothers and babies.  

3.  At least some of the IBCLC's who are in network will be of a category that unfortunately might be described as "you get what you pay for."  These IBCLC's certainly will not be able to afford $1500 scales, and weighed feeds will not be done when appropriate.  They will not be able to afford paperless charting, and especially with all of the new ins. co. paperwork, record keeping will suffer.  They will not be able to afford conferences and continuing education.  We have all, unfortunately, seen situations where IBCLC's did not do a weighed feed when it should have been done.  I have heard too many stories of LC's not examining the mother's breasts or the baby and therefore missing important things.  Who on this list HASN'T identified TT and made a referral and thereby saved a breastfeeding relationship when the mother had seen an LC or sometimes multiple LC's before?  At the very least, the LC's working for the reduced rates are going to have a real incentive to reduce the time they spend with mothers, because they will NEED to see three times as many dyads.   Mothers and babies will fail at breastfeeding because of lack of good help.  I heard from a mother today who was given formula by IBCLC's at a Massachusetts hospital.  Free formula while her baby was gaining 2 ounces a day on her own milk.  The sad part is that they talked her into using some of it.  "Feed the baby is the first rule," they said.  I guess they didn't understand that breastfeeding is feeding.  Bad help is worse than no help!! 

As a policy matter, we should do what dentists have done, that is, stay out of network until insurance companies pay what we deserve.  
Of course we all feel bad for mothers and babies who need help, but, as set forth above, we are not helping anyone by allowing ourselves to be taken advantage of by insurance companies.  Rather, we are derailing our profession and putting ourselves out of business--then where will mothers get good help??  It is short-sighted to think that we can save the world by devaluing our time!  Please do not be fooled when insurance companies throw out the argument about mothers not being able to afford help.
First, YES, this is a very real issue, but that means that the insurance companies should cover it!!  By working for reduced rates, we are in effect serving as insurance for the mothers!  This is not our cost or burden to bear!  We need to be paid for our work.  Like many of the members of this list, I do believe strongly in the importance of volunteer work, but we need to a) choose when and where to volunteer and for whom, and that should not mean volunteering for an insurance company, and b) value our work and not think that everything we do should be on a volunteer basis, because that thinking does not benefit mothers and babies or society in the end.
Second, there are many mothers who can afford help and expect to pay for it, but will end up choosing the free option if they are not aware that they might be getting better service if they actually paid for it.  I do believe that it should be covered for all mothers, but not at the proposed rates.  Further, it does not make sense for us to be providing services at ridiculously low rates when the homes we are visiting are of friends with our same level of education and who would NOT discount their professional time for us and would NOT want to be treated like charity cases.  
Interestingly, 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!  Why are we not asking the insurance company's to be paid the same rate per each 15 minutes that a pediatrician makes???!!!!!  We have MORE expertise than a pediatrician in this area, it only makes sense that we should be paid at least what they are currently paying physicians for this same service, because at least we will be able to provide good lactation help for that same pay! 
This is a second career for me.  I served as general counsel to a large medical research foundation, so I obviously did not change professions to get richer; I chose this profession because I am committed to helping mothers and babies.  But I am not willing or able to be steam-rolled by insurance companies.
If I may be of any help in the negotiating process, please let me know.  
I know I am really preaching to the choir on this list, and I so appreciate all of the people who have been working so hard to achieve a reimbursement status for IBCLC's.  It is really now or never for establishing rates.  As any lawyer or business person will tell you, there is NO negotiating UP.  We really need to take all costs into account, and the experience that we have is unique and we should be paid for it.  At the current proposed rates, it is not worth it for us to get into our cars and risk being hit by an uninsured motorist.  Our families would lose our  services and our income, all while we were out practically volunteering for Aetna.  And there wouldn't even be any worker's comp to cover anything.  And has anyone on this list been able to get worthwhile disability insurance?  We certainly could not even afford that insurance (many thousand of dollars each year)  at Aetna's rates.  
Is anyone paying for childcare while making home visits.  If we are working at rates so low that we couldn't even pay for good childcare, let's think what message we are sending about the value--or lack thereof--of our profession.    We are not helping women and children by preventing women with children whom they need to support from even working in our profession.  
How can we help to make sure that the rates are fair and reasonable?  What specific actions can we all take today to let the insurance companies know that good lactation help cannot be made available for the rates they are talking about. 
Perhaps these numbers were somehow derived from a hospital LC's salary.  And we all know that hospital LC's are underpaid.  Part of that is because women want to help women and so we have worked for less than we deserve.  But it is a terrible cycle.  The ones who really benefit are not the mothers and the babies but the people who are truly making money at the hospitals.  …. As far as salary formulas go, a law firm hiring an attorney looks to make six times the attorney's salary.  That's right, six times, and then 1/6 of it goes to the attorney.  Arguably, reimbursement for an IBCLC in PP should be making six times what an LC at a hospital is making.  Perhaps the number should be even higher because the equation is figured by calculating what is needed to make up for overhead, expenses, continuing education, equipment and supplies, health insurance expenses, disability insurance, etc. 
I welcome all thoughts on how we can best address this situation.



  

On Jul 30, 2012, at 9:38 AM, LACTNET automatic digest system wrote:

> Many IBCLCs may wish to join this network as it will increase your client
> base, market your services to a large number of mothers, and provide
> services for mothers who cannot afford to pay out of pocket for IBCLC
> services. There are many mothers whose only access to the level of care
> that they need is if an IBCLC takes her Aetna insurance. Otherwise her baby
> may be weaned to formula and not receive his/her mother's milk.


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