Hear hear. I have a large flat spot on my forehead from beating my head on this wall. The pediatrician's document really only addressed lactation visits under the billing of a physician as part of the practice. It helps the physician's bottom line (maybe) but it doesn't really help our profession. If folks are to receive best care, they need to be cared for by lactation consultants that are experienced and knowledgeable. That means seeing many patients. That means being reimbursed so that a practice can be financially sustainable. I noticed that some folks see 250 patients a year. If each paid 100 dollars (American) for their care, that's 25,000. After office and supply expenses, utilities etc, that leaves NOTHING for the person to live on. So unless a consultant is subsidized by a willing partner (a physician's office, a hospital, a domestic partner), it is not financially feasible to provide lactation services. If this country is ever going to support breastfeeding, it has to support paying people to help with breastfeeding. Otherwise, people will not stay in a profession that doesn't support the practitioners. There needs to be lactation "therapy" codes that encompass the full range of the lactation consultant's job including assessment, intervention, planning, follow-up and evaluation. I guess because this only is important to mothers and babies, and the majority of LC's are women, it is not a big enough issue. But insurance companies will cover Viagra and implants and assistive devices when other ejectile organs don't work as they should, right?
Not so politically correctly yours,
Jane
-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Debra Swank
Sent: Friday, April 17, 2009 2:22 PM
Subject: hospital lactation consultatants and outpatient services (insurance reimbursement)
I am hopeful that our professional organization(s) can play a strong role in lobbying for health insurance coverage for outpatient lactation services for any mother and baby who is so very fortunate to have health insurance coverage at this time in the United States.
When a stroke patient or a patient recovering from a traumatic brain injury receives care from an occupational therapist who assists the patient in re- learning self-feeding techniques, I presume Medicare, Medicaid, and private forms of health care coverage are rather willing to pay for such skilled care, since one must eat to live.
When a BABY of any age and of any gestational age/preterm/fullterm is helped by a speech pathologist for sucking and/or swallowing concerns, I presume health coverage is a given, should the baby be so fortunate as to actually have some form of health coverage in the United States at present. After all, one must eat to live, and further, the quality of one's life is that of greater health when one receives a species-specific milk. In giving such milk, the mother's health and wellbeing is enhanced as well.
It appears to be a form of discrimination against babies who are nourished at the mother's breast and/or who are nourished with their mother's milk by any feeding method not to have health care coverage extended to them, as it is for their human relatives across the lifespan - - whether preterm or aged - - in regard to health issues related to any any form of feeding, motor learning, and motor control.
How odd and tragic that a grandparent can receive health coverage for physical therapy in treatment of a painful heel spur (my own recent experience, and may I say such care is worth every penny), while across town and across the country, another grandparent's grandbaby cannot be assured of routine health coverage for feeding issues, as well as the mother of the baby for any lactation concerns.
Skin wounds on a human being's body are presumed to be eligible for insurance coverage here, no? That should certainly apply to a mother's nipple wounds, which can be just as excruciating - - and often times more so - - as many
other types of skin wounds.
While I am stunned by the AAP's response to LactNet re: Dr. Jay Gordon's satirical post on April 1st, the July 2008 issue of the AAP's pediatric coding newsletter gave its members valuable information in highlighting the lactation coding for peds care providers. Dr. Christina Smillie is listed as the original author of "Supporting Breastfeeding and Lactation: The Primary Care Pediatrician's Guide to Getting Paid," and Dr. Jenny Thomas contributed to that July '08 article with helpful and insightful vignettes re: lactation management. It seems to me that another female physician very well known in our lactation community also contributed to the lactation coding document, but I cannot presently locate her name. I am also having having difficulty getting the AAP coding document to link to this post - - I can read the July
2008 coding newsletter today but can't find the entire peds/lactation coding document now.
While driving in my car yesterday/running errands, I listened to a powerful interview on C-Span with Supreme Court Associate Justice Ruth Bader Ginsberg. A number of questions asked of her were in regard to her early career as an advocate for equal citizen status for women and men as a constitutional principle, and she recounted some of the poignant cases in which served as a lawyer with the American Civil Liberties Union (ACLU).
(Wikipedia's article on Ginsberg mentions that her work with the ACLU was as a volunteer attorney.) In the C-Span interview, Ginsberg recounted how, in her pregnancy with her second child, she wore her mother-in-law's clothes to disguise her pregnancy (her mother-in-law was a size larger than Ginsberg)- - fearful that her position would be in jeopardy if her pregnancy were revealed.
Her position was an academic one then, and the academic year was ending in May. She was to be away from that academic position due to the summer break, and stated in May to her superior that by September, when the fall term would resume, there would be an additional member in their family - - without stating she was pregnant. She stated with irony that her pregnancy and her subsequent fears about her job security occurred AFTER protection through Title VII of the Civil Rights Act had been written into law. Title VII
includes protection in regard to pregnancy and employment discrimination.
Attorney and IBCLC Liz Brooks and anyone else who may care to comment, what say ye on this discrimination issue against breastfed babies and their breastfeeding mothers? Would this be an issue appropriate for the American Civil Liberties Union to address?
Debra Swank, RN IBCLC
Ashburn, Virginia USA
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