I've used many different ways...in my agency in St. Louis, they had an "official" sliding scale - that is, they asked for information on income and billed accordingly - from $5 to $35 for 30 minute visit. I find that's very difficult, as newly delivered moms and their families are facing extra expenses that may not be usual and customary. I like the ideas mentioned by others about accepting "trade" or dividing the payments by 2 - 3 months. In Proyecto Lacta in Puerto Rico, we told everyone the value of the visit was $50, and they should pay what they can, realizing that those moms who paid the cost were helping out those mothers that could not pay. This meant some moms paid 50 cents - and some paid $100 to help other moms. As we also had a Federal grant and assistance from the hospital where we were housed (no rent, no utilities), we were able to manage...but we DID have to charge for pumps and other equipment, as we rented them. Here in the California county I live, we have private lactation consultants who see moms for payment, and they refer those who cannot pay to La Leche League or to the county Health Department. The Health Department offers services through WIC, Public Health Nursing and the Bureau of Maternal and Child Health, (which employs me). We also collaborate with other agencies that are part of the "Comprehensive Perinatal Services Program" (CPSP). Moms who have Medicaid (Medi-Cal in California) can receive services through CPSP for at least 60 days postpartum - that are paid for by Medi-Cal. Breast pumps are paid for if there is a medical necessity (baby not able to latch on is considered a medical necessity - it doesn't have to be a baby in NICU). WIC has pumps for moms that do not fit into some of the MediCal categories. It's a very awkward system, and we'd like to improve on it as every time an MD or an RN sees a mom having difficulty they have to ask questions about their insurance coverage and income in order to refer them appropriately - otherwise the mom gets one number, may then be told to call another and may be lost in the shuffle. However, we are very proud of the collaboration among all the different groups and agencies. It isn't perfect, but at least we're trying - and working together to improve it through the Breastfeeding Task Force. Ideally (we're trying to convince the - $$ - powers that be - $$ - ) every mom would get a home visit on day 3 - 4 postpartum - depending on their discharge day (shades of the Heinig and Dewey study in Davis, CA) with additional visits as needed. THEN we could hire or contract with IBCLCs to make these visits and provide appropriate help without worrying about who has what insurance! I understand some other counties California already have done this. Jeanette Panchula, BSW, RN, PHN, IBCLC NEW E-mail: mailto:[log in to unmask] *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html