Re: insurance providers

[Guest guest]

There

is ~no way~ any medical provider of any kind, including IBCLCs, can be forced

to accept insurance coverage from Medicaid or any private insurer. This is with

or without the Affordable Care Act. This is entirely the decision of the provider

if they want to be in a network or offer their services as cash/ self-pay only.

Judy

Judith

L. Gutowski, BA, IBCLC, RLC

135 McGrath Lane

P Box 1

Hannastown, PA 15635-0001

Cell

Phone

Fax

[Guest guest]

Jan's point is exactly what makes me nervous. Essentially, the market may force

us to be insurance providers even if it isn't mandatory.

For this season of my life, I have specifically established my practice in a way

that allows my professional life to be simple. I don't sell retail products or

rent pumps, I cover small items like nipple shields in my consult fee, and I

only take cash/checks. My children are still young and I have a spouse who

travels extensively and unpredictably for his job (that pays our bills), so my

goal was to do what I love while still keeping it manageable. Getting on

provider panels and dealing with the reams of paper would significantly

complicate my practice and I'm not sure I have the time to add that extra layer

of complexity on top of my other responsibilities. And beyond that, my little

business runs on a shoestring. I can't afford to wait long stretches of time

for reimbursement or to take a significantly reduced fee.

I work in a hospital as an LC and teach BFing for a big hospital system in

addition to my PP work. While I truly like my hospital job, the PP work I do is

very gratifying, I feel free to practice as I see fit and I feel like I make a

bigger difference in lives of the families I serve because I'm filling a special

niche. The overwhelming complexity of the insurance world might be my tipping

point though. In my hospital job, I show up, punch the clock, do my work, go

home and get paid. End of story. Since I'm prn, I work when I want to and make a

good wage with no paperwork headaches other than mastering the latest update to

our electronic charting system. While I'm not ready to give up my PP, the lack

of headache definitely has appeal.

In my area, there are less than a handful of us in private practice. We are

geographically spread out and serve different clientele, so we aren't really

competing for the same patients. I also have a pretty loyal following among

some midwives and physicians. I hope these things work enough in my favor for

me to be able to continue to be fee for service only and have what I see as the

best of all worlds.

Thanks for letting me rant a bit...

Carroll

I'm sure there will be many moms, particularly in Manhattan,

> who will be willing to pay out of pocket, even if their insurance covers it,

> just to get a specific practitioner. That's what having money does. In my

> area? Not so much. If you aren't accepting insurance the mom will find

> someone that does.

>

> Jan

>

[Guest guest]

has anyone responded to the Aetna thing sent out by USLCA? Letting us know that we could as IBCLC's be a provider? Beebe, M.Ed., RLC, IBCLC Lactation Consultant/Postpartum Doula www.second9months.comwww.facebook.com/thesecond9months To: " " < > Sent: Saturday, July 28, 2012 7:56 PM Subject: Re: Re: insurance providers

I don't know a lot about this but I know that some physicians will cover some insurance plans and not others, so I assume that we will be able to join some and opt out of others, just as they. I'm sure some plans have better reimbursement than others. We can then choose the companies that will give us the most benefit. Cheryl n, IBCLC, RLCOhio To: Sent: Saturday, July 28, 2012 6:32 PM Subject: Re: insurance providers

Judy can an IBCLC OR an organization choose 'both'....meaning you can go in provider with some insurance providers, and not opt in with other insurance providers?

Thanks,

>

> There is ~no way~ any medical provider of any kind, including IBCLCs, can be

> forced to accept insurance coverage from Medicaid or any private insurer.

> This is with or without the Affordable Care Act. This is entirely the

> decision of the provider if they want to be in a network or offer their

> services as cash/ self-pay only.

>

>

>

> Judy

>

> Judith L. Gutowski, BA, IBCLC, RLC

>

> 135 McGrath Lane

>

> P Box 1

>

> Hannastown, PA 15635-0001

>

> Cell Phone

>

> Fax

>

[Guest guest]

I plan on checking into it. If it's easy, I'll sign up.

June

www.cherishthebaby.com

>

> has anyone responded to the Aetna thing sent out by USLCA?  Letting us know

that we could as IBCLC's be a provider?

>  

> Beebe, M.Ed., RLC, IBCLC

[Guest guest]

USLCA has worked extensively with Aetna

to form the processes to “credential” IBCLCs and find appropriate

coding and reimbursement. I have reviewed the initial application for Aetna online which is very simple to complete. The

let5ter tells you how to answer the questions. I have not “completed”

the entire process, because in my circumstances this is going to be done by my

employer (pediatric practice) who will “credential” me for the

organization.

For Aetna, only the

IBCLC will be able to be credentialed as we have educated them on the skills

and qualifications that IBCLCs have to offer. We hope/plan to also educate

other insurance carriers, so if you have opportunity or contacts with any of

those please let me know. The process for Aetna

will include registering with the CAQH, a non-profit universal provider

datasoursce, which will streamline application to multiple providers should

they choose to credential IBCLCs and you choose to work for them. And yes, you

can pick and choose the insurers with which you are willing to contract to

provide services. There will be 2 webinars upcoming, one from USLCA and one

from Aetna, to tell you all you need to know. I

am also in the process of writing a Q and A document which will answer all the

questions you all have posed and others that are coming to my in-box.

You can call the customer service number on the Aetna letter to find out the reimbursement rates for your

geographic location. There are enumerators that vary reimbursement for all

medical billing codes based on locale. In a review of 4 states the 99404 code

for preventive counseling services of 60 minutes ~ which is likely to be the

most used code for lactation ~ will pay between $93 and $123 for the visit. Classes

coded S9443 will also be a covered code. Travel time and expenses cannot be

included in this coding for home visits. This is an existing code that

is used by other types of health care professionals. It is not specific to

lactation evaluation and management. USLCA has applied for a HCPCS Code for

lactation, but we have not received any response yet. If/when this code is

becomes available it may have different rates of reimbursement.

Judy

Judith

L. Gutowski, BA, IBCLC, RLC

Chair,

USLCA Licensure and Reimbursement Committee

135 McGrath Lane

P Box 1

Hannastown, PA 15635-0001

Cell

Phone

Fax

[Guest guest]

Thanks Ellen -- I MADE myself go for a run around the Central Park reservoir

before the exam to clear my congestion. Since I hate running to begin with --

this was a stretch -- but at least Central Park is beautiful and it brought some

much needed oxygen to my head. I actually took a 10 minute nap after the first

run through on the exam because the run gave me just enough oxygen to the brain

to make it that far. Then after my 10 minute nap I went back and answered all

the missed questions and reconsidered all the flagged questions.

sburgernutr@...

[Guest guest]

Because that is what the ACA mandates.

 

And why is the IBCLC being singled out as no cost sharing when other healthcare fields do this all of the time? 

Cheryl n, IBCLC, RLC

To:

Sent:

Tuesday, July 31, 2012 1:08 PM Subject: Re: insurance providers

 

Judith Gutowski posted something on LactNet that is interesting. That the ACA requires that there is no cost sharing with the patient. I know she reads here to, so if you see this, would you mind commenting on the possibility that we as PP LCs might be able to do a combination of self pay and insurance?

Lea Todaro

Brooklyn, NY

[Guest guest]

what is the ACA? Beebe, M.Ed., RLC, IBCLC Lactation Consultant/Postpartum Doula www.second9months.comwww.facebook.com/thesecond9months To: Sent: Tuesday, July 31, 2012 7:04 PM Subject: Re: Re: insurance providers

Because that is what the ACA mandates.

And why is the IBCLC being singled out as no cost sharing when other healthcare fields do this all of the time?

Cheryl n, IBCLC, RLC

To:

Sent:

Tuesday, July 31, 2012 1:08 PM Subject: Re: insurance providers

Judith Gutowski posted something on LactNet that is interesting. That the ACA requires that there is no cost sharing with the patient. I know she reads here to, so if you see this, would you mind commenting on the possibility that we as PP LCs might be able to do a combination of self pay and insurance?

Lea Todaro

Brooklyn, NY

[Guest guest]

So services related to 'well child' exams, and annual physicals etc. are

considered 'preventive' and are to be offered at no cost to the client.

>

> And why is the IBCLC being singled out as no cost sharing when other

healthcare fields do this all of the time?

>  

> Cheryl n, IBCLC, RLC

>

>

> ________________________________

>

> To:

> Sent: Tuesday, July 31, 2012 1:08 PM

> Subject: Re: insurance providers

>

>

>

>  

>

> Judith Gutowski posted something on LactNet that is interesting. That the

ACA requires that there is no cost sharing with the patient. I know she reads

here to, so if you see this, would you mind commenting on the possibility that

we as PP LCs might be able to do a combination of self pay and insurance?

>

> Lea Todaro

> Brooklyn, NY

>

[Guest guest]

I'd never seen it referred to as ACA. now I know. thank you! Beebe, M.Ed., RLC, IBCLC Lactation Consultant/Postpartum Doula www.second9months.comwww.facebook.com/thesecond9months To: Sent: Tuesday, July 31, 2012 7:27 PM Subject: Re: Re: insurance providers

The Affordable Care Act, also known as Obamacare. This part of the act kicks in tomorrow and it covers a range of women's health issues, of which breastfeeding support is just one.Sharon

what is the ACA? Beebe, M.Ed., RLC, IBCLC Lactation Consultant/Postpartum Doula

www.second9months.com

www.facebook.com/thesecond9months

To:

Sent: Tuesday, July 31, 2012 7:04 PM Subject: Re: Re: insurance providers

Because that is what the ACA mandates.

And why is the IBCLC being singled out as no cost sharing when other healthcare fields do this all of the time?

Cheryl n, IBCLC, RLC

To:

Sent:

Tuesday, July 31, 2012 1:08 PM Subject: Re: insurance providers

Judith Gutowski posted something on LactNet that is interesting. That the ACA requires that there is no cost sharing with the patient. I know she reads here to, so if you see this, would you mind commenting on the possibility that we as PP LCs might be able to do a combination of self pay and insurance?

Lea Todaro

Brooklyn, NY