Guest guest Posted August 1, 2011 Report Share Posted August 1, 2011 I don't have childcare to think about, but I do consider my time driving around. last week I saw a mom at my house b/c I new she couldn't afford to pay. It was fine cause I was home anyway and it was really nothing for me out of pocket. For me it's always about how it makes me feel. If it feels like she's taking advantage of you, she probably is. check in with your gut! Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comBreastfeeding Between the Lines: http://second9months.wordpress.com/--- Subject: What do you think?To: Date: Sunday, July 31, 2011, 7:08 PM I have a mom (complicated case) whom I have been spending a lot of time corresponding with. I saw her initially and my fee was a stretch for her then. I let her send me the fee after the fact which I have never done before. She really has needed to see me again but their finances are so tight that she could not afford my fee. I offered her a VERY reduced fee -- one that essentially only covered my childcare expenses -- and she was not able to afford that right now either. I have continued to answer her many questions via email while at the same time setting boundaries with her about what I will and won't do without an in person consult. I have felt very conflicted about this mom. The business person in me says I've already gone far above and beyond to provide her with support and care and that it would be unwise to put myself in the hole by seeing her for no fee. The mom and LLL leader in me says that I should just bite the bullet, pay for my own childcare and go see her for free. The risk manager in me is not sure which path to take. What do the rest of you do when situations like this arise? I do believe that all women,regardless of socioeconomic status, should have access to quality lactation care. I'm just not sure how to apply that belief here. Carroll, MA, IBCLC Lactation Solutions Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 1, 2011 Report Share Posted August 1, 2011 My husband tells me I'm a terrible business woman and he's right. Sometimes if I go to a visit and the mom is crying and crazed, I"ll wait and bill her instead of taking the money right then and there. He tells me, what if she doesn't pay you? I say, I know I know but how could I ask for the money when she's so crazed? I haven't yet been stiffed and probably more appreciated. 's right. Go with your gut. For me, I know it will come back to me in good things. I'll be poor but I will be at peace with myself Dana Schmidt, BS, RN, IBCLCCradlehold, DirectorBreastfeeding Education & Supportwww.cradlehold.netwww.facebook.com/CradleholdBreastfeedingEducationandsupportProviding the minimum amount of intervention for the minimum amount of time for maximum benefit to mother and babyHow Were YOU Supported to Breastfeed?http://www.usbreastfeeding.org/LegislationPolicy/ActionCampaigns/SupportStories/tabid/198/Default.aspxFrom: Beebe To: Sent: Sunday, July 31, 2011 10:16 PMSubject: Re: What do you think? I don't have childcare to think about, but I do consider my time driving around. last week I saw a mom at my house b/c I new she couldn't afford to pay. It was fine cause I was home anyway and it was really nothing for me out of pocket. For me it's always about how it makes me feel. If it feels like she's taking advantage of you, she probably is. check in with your gut! Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comBreastfeeding Between the Lines: http://second9months.wordpress.com/--- Subject: What do you think?To: Date: Sunday, July 31, 2011, 7:08 PM I have a mom (complicated case) whom I have been spending a lot of time corresponding with. I saw her initially and my fee was a stretch for her then. I let her send me the fee after the fact which I have never done before. She really has needed to see me again but their finances are so tight that she could not afford my fee. I offered her a VERY reduced fee -- one that essentially only covered my childcare expenses -- and she was not able to afford that right now either. I have continued to answer her many questions via email while at the same time setting boundaries with her about what I will and won't do without an in person consult. I have felt very conflicted about this mom. The business person in me says I've already gone far above and beyond to provide her with support and care and that it would be unwise to put myself in the hole by seeing her for no fee. The mom and LLL leader in me says that I should just bite the bullet, pay for my own childcare and go see her for free. The risk manager in me is not sure which path to take. What do the rest of you do when situations like this arise? I do believe that all women,regardless of socioeconomic status, should have access to quality lactation care. I'm just not sure how to apply that belief here. Carroll, MA, IBCLC Lactation Solutions Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 1, 2011 Report Share Posted August 1, 2011 Hello, . Yeah, it's tough when we come from a give-it-all-away-for-free background. When wearing my business cap, I only charge half-price for anyone who can prove they are eligible for WIC. (Must show me an appointment card or other official proof, because unfortunately, some do lie to me about their eligibility.) Now, I realize that this is still beyond the means of some people. At that point, I try to figure out if they have actually been seen by their WIC Peer Counselor--if not, I tell them to go there first. If they make just a bit too much to be eligible for WIC but can't afford the fee, I invite them to an LLL meeting, explaining that time there for just one mother is limited, but if baby chooses to nurse there, I *might* be able to see something useful that I can point out to her. (Or if they don't live near me, I suggest they attend a local LLL meeting or call their local LLL Leader if they have not done so since their problem started.) If they have already been seen by WIC and/or LLL and it's obvious they need more in-depth knowledge, I have been known to take a post-dated check if they can tell me there will be a paycheck in the next 4-5 days. I am also set up as a credit card merchant, so they might be able to put it on their credit card and pay that off in parts. If push comes to shove, here is another option I sometimes offer: Divide all fees (consultation fees, any fees for pump parts, etc.) into three equal parts. Add the sales tax due, if any, to the first amount. Mother writes me THREE checks while in my office: The first one is the first third plus sales tax, dated the date of the consultation. The second one is for the second third of the payment due, dated one month later; and the third one is for the last portion of the payment due, dated two months later. I do not feel the need to charge interest, since I don't have to spend time and money sending out reminders--I already have all the checks. Mother knows I can't mess up her budget by putting them in the bank too soon because the bank won't accept a post-dated check. So far (knock on wood), none of the payments done this way have had second or third checks bounce. Another option for you: I imagine you don't have an office since you do in-home visits. But instead of paying childcare, could your spouse/own mother/?? watch your kids in your own home, while you see the mother in your own living room or dining room or basement, or somewhere where you can set up a little privacy? If you don't have to pay for gas and don't have to pay for childcare, maybe you'd feel better about doing one pro bono consultation for this mother. Dee Kassing Subject: What do you think?To: Date: Sunday, July 31, 2011, 9:08 PM I have a mom (complicated case) whom I have been spending a lot of time corresponding with. I saw her initially and my fee was a stretch for her then. I let her send me the fee after the fact which I have never done before. She really has needed to see me again but their finances are so tight that she could not afford my fee. I offered her a VERY reduced fee -- one that essentially only covered my childcare expenses -- and she was not able to afford that right now either. I have continued to answer her many questions via email while at the same time setting boundaries with her about what I will and won't do without an in person consult.I have felt very conflicted about this mom. The business person in me says I've already gone far above and beyond to provide her with support and care and that it would be unwise to put myself in the hole by seeing her for no fee. The mom and LLL leader in me says that I should just bite the bullet, pay for my own childcare and go see her for free. The risk manager in me is not sure which path to take. What do the rest of you do when situations like this arise?I do believe that all women,regardless of socioeconomic status, should have access to quality lactation care. I'm just not sure how to apply that belief here. Carroll, MA, IBCLCLactation Solutions Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 1, 2011 Report Share Posted August 1, 2011 I don't think we have to be poor. I've started asking moms in that situation what THEY feel comfortable paying. I am always surprised b/c they usual state an amount that is totally acceptable and more than I anticipated... Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comBreastfeeding Between the Lines: http://second9months.wordpress.com/--- On Sun, 7/31/11, Dana Schmidt wrote:Subject: Re: What do you think?To: " " < >Date: Sunday, July 31, 2011, 7:22 PM My husband tells me I'm a terrible business woman and he's right. Sometimes if I go to a visit and the mom is crying and crazed, I"ll wait and bill her instead of taking the money right then and there. He tells me, what if she doesn't pay you? I say, I know I know but how could I ask for the money when she's so crazed? I haven't yet been stiffed and probably more appreciated. 's right. Go with your gut. For me, I know it will come back to me in good things. I'll be poor but I will be at peace with myself Dana Schmidt, BS, RN, IBCLCCradlehold, DirectorBreastfeeding Education & Supportwww.cradlehold.netwww.facebook.com/CradleholdBreastfeedingEducationandsupportProviding the minimum amount of intervention for the minimum amount of time for maximum benefit to mother and babyHow Were YOU Supported to Breastfeed?http://www.usbreastfeeding.org/LegislationPolicy/ActionCampaigns/SupportStories/tabid/198/Default.aspxFrom: Beebe To: Sent: Sunday, July 31, 2011 10:16 PMSubject: Re: What do you think? I don't have childcare to think about, but I do consider my time driving around. last week I saw a mom at my house b/c I new she couldn't afford to pay. It was fine cause I was home anyway and it was really nothing for me out of pocket. For me it's always about how it makes me feel. If it feels like she's taking advantage of you, she probably is. check in with your gut! Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comBreastfeeding Between the Lines: http://second9months.wordpress.com/--- Subject: What do you think?To: Date: Sunday, July 31, 2011, 7:08 PM I have a mom (complicated case) whom I have been spending a lot of time corresponding with. I saw her initially and my fee was a stretch for her then. I let her send me the fee after the fact which I have never done before. She really has needed to see me again but their finances are so tight that she could not afford my fee. I offered her a VERY reduced fee -- one that essentially only covered my childcare expenses -- and she was not able to afford that right now either. I have continued to answer her many questions via email while at the same time setting boundaries with her about what I will and won't do without an in person consult. I have felt very conflicted about this mom. The business person in me says I've already gone far above and beyond to provide her with support and care and that it would be unwise to put myself in the hole by seeing her for no fee. The mom and LLL leader in me says that I should just bite the bullet, pay for my own childcare and go see her for free. The risk manager in me is not sure which path to take. What do the rest of you do when situations like this arise? I do believe that all women,regardless of socioeconomic status, should have access to quality lactation care. I'm just not sure how to apply that belief here. Carroll, MA, IBCLC Lactation Solutions Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 1, 2011 Report Share Posted August 1, 2011 Ladies, wrote “I have a mom (complicated case) whom I have been spending a lot of time corresponding with. I saw her initially and my fee was a stretch for her then. I let her send me the fee after the fact which I have never done before. She really has needed to see me again but their finances are so tight that she could not afford my fee.” wrote “I don't have childcare to think about, but I do consider my time driving around. last week I saw a mom at my house b/c I new she couldn't afford to pay. It was fine cause I was home anyway and it was really nothing for me out of pocket.” Dee wrote “When wearing my business cap, I only charge half-price for anyone who can prove they are eligible for WIC. (Must show me an appointment card or other official proof, because unfortunately, some do lie to me about their eligibility.) Now, I realize that this is still beyond the means of some people. At that point, I try to figure out if they have actually been seen by their WIC Peer Counselor--if not, I tell them to go there first. If they make just a bit too much to be eligible for WIC but can't afford the fee, I invite them to an LLL meeting, explaining that time there for just one mother is limited, but if baby chooses to nurse there, I *might* be able to see something useful that I can point out to her. (Or if they don't live near me, I suggest they attend a local LLL meeting or call their local LLL Leader if they have not done so since their problem started.) If they have already been seen by WIC and/or LLL and it's obvious they need more in-depth knowledge, I have been known to take a post-dated check if they can tell me there will be a paycheck in the next 4-5 days. I am also set up as a credit card merchant, so they might be able to put it on their credit card and pay that off in parts.” This is an important discussion about the difficulty balancing client care and earning a living. It is quite revealing of the problems mothers have with access to professional lactation support. It is important that lactation support, as preventive health care, for mother and baby be covered by insurance. We have pending policies right now from the IOM, Clinical Preventive Services for Women: Closing the Gaps http://www.iom.edu/Reports/2011/Clinical-Preventive-Services-for-Women-Closing-the-Gaps.aspx Recommendation 5.6: Comprehensive lactation support and counseling and costs of renting breastfeeding equipment. A trained provider should provide counseling services to all pregnant women and to those in the postpartum period to ensure the successful initiation and duration of breastfeeding. (The ACA ensures that breastfeeding counseling is covered; however, the committee recognizes that interpretation of this varies.) Primary Care Interventions to Promote Breastfeeding http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrfd.htm The US Preventive Services TaskForce recommends interventions during pregnancy and after birth to promote and support breastfeeding. These are to be covered beginning 2013 under the Affordable Care Act. Grade: B recommendation. Interventions to promote and support breastfeeding have been found to increase the rates of initiation, duration, and exclusivity of breastfeeding. Consider multiple strategies, including: · Formal breastfeeding education for mothers and families · Direct support of mothers during breastfeeding · Training of primary care staff about breastfeeding and techniques for breastfeeding support · Peer support Interventions that include both prenatal and postnatal components may be most effective at increasing breastfeeding duration. In rare circumstances, for example for mothers with HIV and infants with galactosemia, breastfeeding is not recommended. Interventions to promote breastfeeding should empower individuals to make informed choices supported by the best available evidence. If any of you are willing and able a concise letter regarding the problems you have in providing care due to finanacial barriers for mother, this would be extremely helpful to the work of USLCA Licensure and Reimbursement Committee. We would use it as evidence in legislative hearings regarding licensure and documentation of problems for insurers. We are in talks with Medicaid administrators and also beginning to reach out to Medicaid Directors at the state level about this issue. Medicaid will not pay for the services of IBCLCs are present because we are not licensed providers. At this time, you could also send a letter in support of the IOM policy recommendation which is pending approval to : The Honorable Kathleen Sebelius Secretary, US Department of Health and Human Services 200 Independence Ave, SW Washington DC 20201 Please be aware that mail sent to our Washington D.C area offices takes an additional 3-4 days to process Or Toll Free: 1- Or Complete an online form at this link. Also, I would like permission to forward this message with you quotes, , Dee and to some other IBCLC listserv to make the same request. It would go to only listserv’s that have limited membership, USLCA Licensure and, Reimbursement committee, PA LCLicensure, Judy Judith L. Gutowski, BA, IBCLC, RLC 135 McGrath Lane P Box 1 Hannastown, PA 15635-0001 Cell Phone Fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 1, 2011 Report Share Posted August 1, 2011 When you say Medicaid will not reimburse in ibclc's ...ate you speaking only of PA? I do believe each state is set up differently and some do reimburse Ibclc directly.Thank you,Sent from my iPhone Ladies, wrote “I have a mom (complicated case) whom I have been spending a lot of time corresponding with. I saw her initially and my fee was a stretch for her then. I let her send me the fee after the fact which I have never done before. She really has needed to see me again but their finances are so tight that she could not afford my fee.†wrote “I don't have childcare to think about, but I do consider my time driving around. last week I saw a mom at my house b/c I new she couldn't afford to pay. It was fine cause I was home anyway and it was really nothing for me out of pocket.†Dee wrote “When wearing my business cap, I only charge half-price for anyone who can prove they are eligible for WIC. (Must show me an appointment card or other official proof, because unfortunately, some do lie to me about their eligibility.) Now, I realize that this is still beyond the means of some people. At that point, I try to figure out if they have actually been seen by their WIC Peer Counselor--if not, I tell them to go there first. If they make just a bit too much to be eligible for WIC but can't afford the fee, I invite them to an LLL meeting, explaining that time there for just one mother is limited, but if baby chooses to nurse there, I *might* be able to see something useful that I can point out to her. (Or if they don't live near me, I suggest they attend a local LLL meeting or call their local LLL Leader if they have not done so since their problem started.) If they have already been seen by WIC and/or LLL and it's obvious they need more in-depth knowledge, I have been known to take a post-dated check if they can tell me there will be a paycheck in the next 4-5 days. I am also set up as a credit card merchant, so they might be able to put it on their credit card and pay that off in parts.†This is an important discussion about the difficulty balancing client care and earning a living. It is quite revealing of the problems mothers have with access to professional lactation support. It is important that lactation support, as preventive health care, for mother and baby be covered by insurance. We have pending policies right now from the IOM, Clinical Preventive Services for Women: Closing the Gaps http://www.iom.edu/Reports/2011/Clinical-Preventive-Services-for-Women-Closing-the-Gaps.aspx Recommendation 5.6: Comprehensive lactation support and counseling and costs of renting breastÂfeeding equipment. A trained provider should provide counseling services to all pregnant women and to those in the postpartum period to ensure the successful initiaÂtion and duration of breastfeeding. (The ACA ensures that breastfeeding counseling is covered; however, the committee recognizes that interpretation of this varies.) Primary Care Interventions to Promote Breastfeeding http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrfd.htm The US Preventive Services TaskForce recommends interventions during pregnancy and after birth to promote and support breastfeeding. These are to be covered beginning 2013 under the Affordable Care Act. Grade: B recommendation. Interventions to promote and support breastfeeding have been found to increase the rates of initiation, duration, and exclusivity of breastfeeding. Consider multiple strategies, including: · Formal breastfeeding education for mothers and families · Direct support of mothers during breastfeeding · Training of primary care staff about breastfeeding and techniques for breastfeeding support · Peer support Interventions that include both prenatal and postnatal components may be most effective at increasing breastfeeding duration. In rare circumstances, for example for mothers with HIV and infants with galactosemia, breastfeeding is not recommended. Interventions to promote breastfeeding should empower individuals to make informed choices supported by the best available evidence. If any of you are willing and able a concise letter regarding the problems you have in providing care due to finanacial barriers for mother, this would be extremely helpful to the work of USLCA Licensure and Reimbursement Committee. We would use it as evidence in legislative hearings regarding licensure and documentation of problems for insurers. We are in talks with Medicaid administrators and also beginning to reach out to Medicaid Directors at the state level about this issue. Medicaid will not pay for the services of IBCLCs are present because we are not licensed providers. At this time, you could also send a letter in support of the IOM policy recommendation which is pending approval to : The Honorable Kathleen Sebelius Secretary, US Department of Health and Human Services 200 Independence Ave, SW Washington DC 20201 Please be aware that mail sent to our Washington D.C area offices takes an additional 3-4 days to process Or Toll Free: 1- Or Complete an online form at this link. Also, I would like permission to forward this message with you quotes, , Dee and to some other IBCLC listserv to make the same request. It would go to only listserv’s that have limited membership, USLCA Licensure and, Reimbursement committee, PA LCLicensure, Judy Judith L. Gutowski, BA, IBCLC, RLC 135 McGrath Lane P Box 1 Hannastown, PA 15635-0001 Cell Phone Fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 1, 2011 Report Share Posted August 1, 2011 Hi ,I hear ya!How can we NOT help a mother breastfeed?When a mother calls for an appointment, I am upfront about fees. - Does she understand that I charge for consultations? - Has she seen my fee schedule on my website? - Yes, a check or cash will be fine.If she tells me she cannot afford my fees:(In descending order) - Would it be easier to pay in installments? - How much CAN she afford to pay? (Usually this is more than I expected!) - Could she pay half the regular fee? - Last attempt - share information about local free support meetings.normaNorma Ritter, IBCLC, RLCBreastfeeding Matters in the Capital Region www.NormaRitter.comJoin us on Facebook for the latest birthing and breastfeeding news and views:http://tinyurl.com/BMCRonFB I have a mom (complicated case) whom I have been spending a lot of time corresponding with. I saw her initially and my fee was a stretch for her then. I let her send me the fee after the fact which I have never done before. She really has needed to see me again but their finances are so tight that she could not afford my fee. I offered her a VERY reduced fee -- one that essentially only covered my childcare expenses -- and she was not able to afford that right now either. I have continued to answer her many questions via email while at the same time setting boundaries with her about what I will and won't do without an in person consult. I have felt very conflicted about this mom. The business person in me says I've already gone far above and beyond to provide her with support and care and that it would be unwise to put myself in the hole by seeing her for no fee. The mom and LLL leader in me says that I should just bite the bullet, pay for my own childcare and go see her for free. The risk manager in me is not sure which path to take. What do the rest of you do when situations like this arise? I do believe that all women,regardless of socioeconomic status, should have access to quality lactation care. I'm just not sure how to apply that belief here. Carroll, MA, IBCLC Lactation Solutions Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 1, 2011 Report Share Posted August 1, 2011 sure, Judy. you have my permission! Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comBreastfeeding Between the Lines: http://second9months.wordpress.com/--- Subject: Re: What do you think?To: Date: Monday, August 1, 2011, 5:48 AM Ladies, wrote “I have a mom (complicated case) whom I have been spending a lot of time corresponding with. I saw her initially and my fee was a stretch for her then. I let her send me the fee after the fact which I have never done before. She really has needed to see me again but their finances are so tight that she could not afford my fee.†wrote “I don't have childcare to think about, but I do consider my time driving around. last week I saw a mom at my house b/c I new she couldn't afford to pay. It was fine cause I was home anyway and it was really nothing for me out of pocket.†Dee wrote “When wearing my business cap, I only charge half-price for anyone who can prove they are eligible for WIC. (Must show me an appointment card or other official proof, because unfortunately, some do lie to me about their eligibility. ) Now, I realize that this is still beyond the means of some people. At that point, I try to figure out if they have actually been seen by their WIC Peer Counselor--if not, I tell them to go there first. If they make just a bit too much to be eligible for WIC but can't afford the fee, I invite them to an LLL meeting, explaining that time there for just one mother is limited, but if baby chooses to nurse there, I *might* be able to see something useful that I can point out to her. (Or if they don't live near me, I suggest they attend a local LLL meeting or call their local LLL Leader if they have not done so since their problem started.) If they have already been seen by WIC and/or LLL and it's obvious they need more in-depth knowledge, I have been known to take a post-dated check if they can tell me there will be a paycheck in the next 4-5 days. I am also set up as a credit card merchant, so they might be able to put it on their credit card and pay that off in parts.†This is an important discussion about the difficulty balancing client care and earning a living. It is quite revealing of the problems mothers have with access to professional lactation support. It is important that lactation support, as preventive health care, for mother and baby be covered by insurance. We have pending policies right now from the IOM, Clinical Preventive Services for Women: Closing the Gaps http://www.iom.edu/Reports/2011/Clinical-Preventive-Services-for-Women-Closing-the-Gaps.aspx Recommendation 5.6: Comprehensive lactation support and counseling and costs of renting breastÂfeeding equipment. A trained provider should provide counseling services to all pregnant women and to those in the postpartum period to ensure the successful initiaÂtion and duration of breastfeeding. (The ACA ensures that breastfeeding counseling is covered; however, the committee recognizes that interpretation of this varies.) Primary Care Interventions to Promote Breastfeeding http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrfd.htm The US Preventive Services TaskForce recommends interventions during pregnancy and after birth to promote and support breastfeeding. These are to be covered beginning 2013 under the Affordable Care Act. Grade: B recommendation. Interventions to promote and support breastfeeding have been found to increase the rates of initiation, duration, and exclusivity of breastfeeding. Consider multiple strategies, including: · Formal breastfeeding education for mothers and families · Direct support of mothers during breastfeeding · Training of primary care staff about breastfeeding and techniques for breastfeeding support · Peer support Interventions that include both prenatal and postnatal components may be most effective at increasing breastfeeding duration. In rare circumstances, for example for mothers with HIV and infants with galactosemia, breastfeeding is not recommended. Interventions to promote breastfeeding should empower individuals to make informed choices supported by the best available evidence. If any of you are willing and able a concise letter regarding the problems you have in providing care due to finanacial barriers for mother, this would be extremely helpful to the work of USLCA Licensure and Reimbursement Committee. We would use it as evidence in legislative hearings regarding licensure and documentation of problems for insurers. We are in talks with Medicaid administrators and also beginning to reach out to Medicaid Directors at the state level about this issue. Medicaid will not pay for the services of IBCLCs are present because we are not licensed providers. At this time, you could also send a letter in support of the IOM policy recommendation which is pending approval to : The Honorable Kathleen Sebelius Secretary , US Department of Health and Human Services 200 Independence Ave, SW Washington DC 20201 Please be aware that mail sent to our Washington D.C area offices takes an additional 3-4 days to process Or Toll Free: 1- Or Complete an online form at this link. Also, I would like permission to forward this message with you quotes, , Dee and to some other IBCLC listserv to make the same request. It would go to only listserv’s that have limited membership, USLCA Licensure and, Reimbursement committee, PA LCLicensure, Judy Judith L. Gutowski, BA, IBCLC, RLC 135 McGrath Lane P Box 1 Hannastown, PA 15635-0001 Cell Phone Fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 1, 2011 Report Share Posted August 1, 2011 Judy, I know you and others are working hard on licensure, and I am not discounting your efforts. But to be honest, I don't think this is going to help us get any income! Getting insurance coverage??? Puh-leeze! My daughter's emergency appendectomy was originally billed at over $20,000 (U.S. dollars), including surgery, hospital stay, anesthesiologist, radiologist, etc. Altogether, insurance paid out only a little over $2,000. One test was billed at over $200 and they were paid less than $1 for it. And they have no recourse to collect more since they have agreed to abide by the insurance carrier's payments. While my husband and I were happy that we didn't have to pay over $20,000, we were truly appalled at how little all the providers were paid for their services. And of course, all that unpaid amount is then dumped on those without insurance. Even if insurance starts to pay for IBCLC care, I won't ever accept insurance. I live in an economically depressed region, so my fee is much lower than most of you anyway. Insurance would look at the "usual" rate and of course downgrade it. To take less than my fee would be pointless and make me close my doors altogether. Already here there are numerous doctors who no longer accept ANY Medicaid patients and who won't accept any new Medicare patients, because the reimbursement rate is so low that the docs can't pay their staff and their electric bill when they care for these patients. I still don't see why we are even trying to get into this racket. Dee Kassing Subject: Re: What do you think?To: Date: Monday, August 1, 2011, 7:48 AM Ladies, wrote “I have a mom (complicated case) whom I have been spending a lot of time corresponding with. I saw her initially and my fee was a stretch for her then. I let her send me the fee after the fact which I have never done before. She really has needed to see me again but their finances are so tight that she could not afford my fee.†wrote “I don't have childcare to think about, but I do consider my time driving around. last week I saw a mom at my house b/c I new she couldn't afford to pay. It was fine cause I was home anyway and it was really nothing for me out of pocket.†Dee wrote “When wearing my business cap, I only charge half-price for anyone who can prove they are eligible for WIC. (Must show me an appointment card or other official proof, because unfortunately, some do lie to me about their eligibility. ) Now, I realize that this is still beyond the means of some people. At that point, I try to figure out if they have actually been seen by their WIC Peer Counselor--if not, I tell them to go there first. If they make just a bit too much to be eligible for WIC but can't afford the fee, I invite them to an LLL meeting, explaining that time there for just one mother is limited, but if baby chooses to nurse there, I *might* be able to see something useful that I can point out to her. (Or if they don't live near me, I suggest they attend a local LLL meeting or call their local LLL Leader if they have not done so since their problem started.)If they have already been seen by WIC and/or LLL and it's obvious they need more in-depth knowledge, I have been known to take a post-dated check if they can tell me there will be a paycheck in the next 4-5 days. I am also set up as a credit card merchant, so they might be able to put it on their credit card and pay that off in parts.†This is an important discussion about the difficulty balancing client care and earning a living. It is quite revealing of the problems mothers have with access to professional lactation support. It is important that lactation support, as preventive health care, for mother and baby be covered by insurance. We have pending policies right now from the IOM, Clinical Preventive Services for Women: Closing the Gaps http://www.iom.edu/Reports/2011/Clinical-Preventive-Services-for-Women-Closing-the-Gaps.aspx Recommendation 5.6: Comprehensive lactation support and counseling and costs of renting breastfeeding equipment. A trained provider should provide counseling services to all pregnant women and to those in the postpartum period to ensure the successful initiation and duration of breastfeeding. (The ACA ensures that breastfeeding counseling is covered; however, the committee recognizes that interpretation of this varies.) Primary Care Interventions to Promote Breastfeeding http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrfd.htm The US Preventive Services TaskForce recommends interventions during pregnancy and after birth to promote and support breastfeeding. These are to be covered beginning 2013 under the Affordable Care Act. Grade: B recommendation. Interventions to promote and support breastfeeding have been found to increase the rates of initiation, duration, and exclusivity of breastfeeding. Consider multiple strategies, including: · Formal breastfeeding education for mothers and families · Direct support of mothers during breastfeeding · Training of primary care staff about breastfeeding and techniques for breastfeeding support · Peer support Interventions that include both prenatal and postnatal components may be most effective at increasing breastfeeding duration. In rare circumstances, for example for mothers with HIV and infants with galactosemia, breastfeeding is not recommended. Interventions to promote breastfeeding should empower individuals to make informed choices supported by the best available evidence. If any of you are willing and able a concise letter regarding the problems you have in providing care due to finanacial barriers for mother, this would be extremely helpful to the work of USLCA Licensure and Reimbursement Committee. We would use it as evidence in legislative hearings regarding licensure and documentation of problems for insurers. We are in talks with Medicaid administrators and also beginning to reach out to Medicaid Directors at the state level about this issue. Medicaid will not pay for the services of IBCLCs are present because we are not licensed providers. At this time, you could also send a letter in support of the IOM policy recommendation which is pending approval to : The Honorable Kathleen Sebelius Secretary , US Department of Health and Human Services 200 Independence Ave, SW Washington DC 20201 Please be aware that mail sent to our Washington D.C area offices takes an additional 3-4 days to process Or Toll Free: 1- Or Complete an online form at this link. Also, I would like permission to forward this message with you quotes, , Dee and to some other IBCLC listserv to make the same request. It would go to only listserv’s that have limited membership, USLCA Licensure and, Reimbursement committee, PA LCLicensure, Judy Judith L. Gutowski, BA, IBCLC, RLC 135 McGrath Lane P Box 1 Hannastown, PA 15635-0001 Cell Phone Fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 1, 2011 Report Share Posted August 1, 2011 I 100% agree with Dee. I don't speak up often cuz I am so crazy busy, but I will quickly say that I do believe that neither birth or breastfeeding are medical issues. They are physiological, not pathological by nature. Both are inherently safe, natural, normal bodily processes. I do not accept insurance either and it is because I am not a medical professional, nor do I provide a medical service. If, for some reason a pathological issue arises that truly makes the situation medical at that point it is important for me to realize that it is out of scope of practice anyway and collaborate with someone in the medical field. I think if we think insurance or licensure changes anything that we all need to read and read and read on the history of midwifery to understand that we will never be a part of the medical 'club'. I for one have no desire to be. I could go on and on and on & have been meaning to do a blog post on this, again I just don't have the time right now but just wanted to say I'm in agreement and when I eventually get around to writing down everything on the subject I will post it here as well ~Karinda Judy, I know you and others are working hard on licensure, and I am not discounting your efforts. But to be honest, I don't think this is going to help us get any income! Getting insurance coverage??? Puh-leeze! My daughter's emergency appendectomy was originally billed at over $20,000 (U.S. dollars), including surgery, hospital stay, anesthesiologist, radiologist, etc. Altogether, insurance paid out only a little over $2,000. One test was billed at over $200 and they were paid less than $1 for it. And they have no recourse to collect more since they have agreed to abide by the insurance carrier's payments. While my husband and I were happy that we didn't have to pay over $20,000, we were truly appalled at how little all the providers were paid for their services. And of course, all that unpaid amount is then dumped on those without insurance. Even if insurance starts to pay for IBCLC care, I won't ever accept insurance. I live in an economically depressed region, so my fee is much lower than most of you anyway. Insurance would look at the " usual " rate and of course downgrade it. To take less than my fee would be pointless and make me close my doors altogether. Already here there are numerous doctors who no longer accept ANY Medicaid patients and who won't accept any new Medicare patients, because the reimbursement rate is so low that the docs can't pay their staff and their electric bill when they care for these patients. I still don't see why we are even trying to get into this racket. Dee Kassing Subject: Re: What do you think? To: Date: Monday, August 1, 2011, 7:48 AM Ladies, wrote “I have a mom (complicated case) whom I have been spending a lot of time corresponding with. I saw her initially and my fee was a stretch for her then. I let her send me the fee after the fact which I have never done before. She really has needed to see me again but their finances are so tight that she could not afford my fee.” wrote “I don't have childcare to think about, but I do consider my time driving around. last week I saw a mom at my house b/c I new she couldn't afford to pay. It was fine cause I was home anyway and it was really nothing for me out of pocket.” Dee wrote “When wearing my business cap, I only charge half-price for anyone who can prove they are eligible for WIC. (Must show me an appointment card or other official proof, because unfortunately, some do lie to me about their eligibility. ) Now, I realize that this is still beyond the means of some people. At that point, I try to figure out if they have actually been seen by their WIC Peer Counselor--if not, I tell them to go there first. If they make just a bit too much to be eligible for WIC but can't afford the fee, I invite them to an LLL meeting, explaining that time there for just one mother is limited, but if baby chooses to nurse there, I *might* be able to see something useful that I can point out to her. (Or if they don't live near me, I suggest they attend a local LLL meeting or call their local LLL Leader if they have not done so since their problem started.)If they have already been seen by WIC and/or LLL and it's obvious they need more in-depth knowledge, I have been known to take a post-dated check if they can tell me there will be a paycheck in the next 4-5 days. I am also set up as a credit card merchant, so they might be able to put it on their credit card and pay that off in parts.” This is an important discussion about the difficulty balancing client care and earning a living. It is quite revealing of the problems mothers have with access to professional lactation support. It is important that lactation support, as preventive health care, for mother and baby be covered by insurance. We have pending policies right now from the IOM, Clinical Preventive Services for Women: Closing the Gaps http://www.iom.edu/Reports/2011/Clinical-Preventive-Services-for-Women-Closing-the-Gaps.aspx Recommendation 5.6: Comprehensive lactation support and counseling and costs of renting breastfeeding equipment. A trained provider should provide counseling services to all pregnant women and to those in the postpartum period to ensure the successful initiation and duration of breastfeeding. (The ACA ensures that breastfeeding counseling is covered; however, the committee recognizes that interpretation of this varies.) Primary Care Interventions to Promote Breastfeeding http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrfd.htm The US Preventive Services TaskForce recommends interventions during pregnancy and after birth to promote and support breastfeeding. These are to be covered beginning 2013 under the Affordable Care Act. Grade: B recommendation. Interventions to promote and support breastfeeding have been found to increase the rates of initiation, duration, and exclusivity of breastfeeding. Consider multiple strategies, including: · Formal breastfeeding education for mothers and families · Direct support of mothers during breastfeeding · Training of primary care staff about breastfeeding and techniques for breastfeeding support · Peer support Interventions that include both prenatal and postnatal components may be most effective at increasing breastfeeding duration. In rare circumstances, for example for mothers with HIV and infants with galactosemia, breastfeeding is not recommended. Interventions to promote breastfeeding should empower individuals to make informed choices supported by the best available evidence. If any of you are willing and able a concise letter regarding the problems you have in providing care due to finanacial barriers for mother, this would be extremely helpful to the work of USLCA Licensure and Reimbursement Committee. We would use it as evidence in legislative hearings regarding licensure and documentation of problems for insurers. We are in talks with Medicaid administrators and also beginning to reach out to Medicaid Directors at the state level about this issue. Medicaid will not pay for the services of IBCLCs are present because we are not licensed providers. At this time, you could also send a letter in support of the IOM policy recommendation which is pending approval to : The Honorable Kathleen Sebelius Secretary , US Department of Health and Human Services 200 Independence Ave, SW Washington DC 20201 Please be aware that mail sent to our Washington D.C area offices takes an additional 3-4 days to process Or Toll Free: 1- Or Complete an online form at this link. Also, I would like permission to forward this message with you quotes, , Dee and to some other IBCLC listserv to make the same request. It would go to only listserv’s that have limited membership, USLCA Licensure and, Reimbursement committee, PA LCLicensure, Judy Judith L. Gutowski, BA, IBCLC, RLC 135 McGrath Lane P Box 1 Hannastown, PA 15635-0001 Cell Phone Fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2011 Report Share Posted August 2, 2011 Yes, all, it worries me too! And if I were to "take" insurance meaning bill the insurance co. for my clients, that would mean I would need a staff. and that would mean raising rates which I would have to do anyway since insurance would only cover a percentage of my fee. Everyone would have to raise rates and insurance premiums keep going up and we'd all be part of this nutty spiral.Still I don't know what the answer is. If licensure helps "legitimize" our field,, I'm all for it. Currently many insurance companies cover my visits 80-100% and I don't do any billing. I would be very happy if that trend continued w/o my having to contract with insurance and do their bidding.And , I got you beat. I drive a '96 mercury sable. (giggle) and I sure hope it keeps running! I understand the whole priority thing. spending a ton on good food in seattle, but rarely buying bling or new purses! My biggest dream in terms of IBCLC's is that IBCLC starts to mean something all by itself!Warmly, Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comBreastfeeding Between the Lines: http://second9months.wordpress.com/--- On Mon, 8/1/11, wrote:Subject: Re: What do you think?To: Date: Monday, August 1, 2011, 4:12 PM I agree Dee--I would never take insurance. I have said this before and will say it again--as little as allopathic providers get--holistic providers get even less, bc we spend so long with our clients. I would do something else with my life before I would do that. In our family--we always made the priorities these--healthy foods and a healthy environment (ie cleaning products/skin care/etc), health care (we never used allopathic medicine) and education. Everything else could wait or be less than the best. When I moved out of my house last year--our family television was older than my 21 year old son, my car was a 98 Subaru. It is not for me to say what folks should value, but if they do not value excellent preventive care, that is a choice they make. I would rather help moms who cannot afford it for free or on a payment plan than work for an insurance company and otherwise, I think folks need to rethink their priorities if they want care. And to add perspective--much as I actually believe in socialized medicine conceptually--here in France, HCPs earn a lot less money than in the States. They also do not have the insurance costs and worries and they have a lot of power!! But, I have yet to see a single doctor who has a receptionist and doesn't take his own payments at his desk before you leave (the veterinarian does though!!) And no one has shiny new offices--they look like the doctors' offices from when I was a kid. Actually, come to think of it--chiropactic isn't covered here and the chiropractor has the nicest office of the docs I have seen (mostly allopathic--going with babies for TT or my son having a physical). Still, I wonder how many US docs would trade the misery of malpractice worries for lower incomes and a lot more vacation time? Got a bit OT....sorry, but my point--with the insurance system we have in the US--I am simply not interested. Tow, IBCLC, France > > > > Subject: Re: What do you think? > To: > Date: Monday, August 1, 2011, 7:48 AM > > > > > > > > > Ladies, > > wrote “I have a mom (complicated case) whom I have been spending a lot of time corresponding with. I saw her initially and my fee was a stretch for her then. I let her send me the fee after the fact which I have never done before. She really has needed to see me again but their finances are so tight that she could not afford my fee.†> > wrote “I don't have childcare to think about, but I do consider my time driving around. last week I saw a mom at my house b/c I new she couldn't afford to pay. It was fine cause I was home anyway and it was really nothing for me out of pocket.†> > Dee wrote “When wearing my business cap, I only charge half-price for anyone who can prove they are eligible for WIC. (Must show me an appointment card or other official proof, because unfortunately, some do lie to me about their eligibility. ) Now, I realize that this is still beyond the means of some people. At that point, I try to figure out if they have actually been seen by their WIC Peer Counselor--if not, I tell them to go there first. If they make just a bit too much to be eligible for WIC but can't afford the fee, I invite them to an LLL meeting, explaining that time there for just one mother is limited, but if baby chooses to nurse there, I *might* be able to see something useful that I can point out to her. (Or if they don't live near me, I suggest they attend a local LLL meeting or call their local LLL Leader if they have not done so since their problem started.) > If they have already been seen by WIC and/or LLL and it's obvious they need more in-depth knowledge, I have been known to take a post-dated check if they can tell me there will be a paycheck in the next 4-5 days. I am also set up as a credit card merchant, so they might be able to put it on their credit card and pay that off in parts.†> > > This is an important discussion about the difficulty balancing client care and earning a living. It is quite revealing of the problems mothers have with access to professional lactation support. It is important that lactation support, as preventive health care, for mother and baby be covered by insurance. We have pending policies right now from the IOM, Clinical Preventive Services for Women: Closing the Gaps http://www.iom.edu/Reports/2011/Clinical-Preventive-Services-for-Women-Closing-the-Gaps.aspx > > Recommendation 5.6: Comprehensive lactation support and counseling and costs of renting breastÂfeeding equipment. A trained provider should provide counseling services to all pregnant women and to those in the postpartum period to ensure the successful initiaÂtion and duration of breastfeeding. (The ACA ensures that breastfeeding counseling is covered; however, the committee recognizes that interpretation of this varies.) > > > Primary Care Interventions to Promote Breastfeeding http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrfd.htm The US Preventive Services TaskForce recommends interventions during pregnancy and after birth to promote and support breastfeeding. These are to be covered beginning 2013 under the Affordable Care Act. > Grade: B recommendation. > Interventions to promote and support breastfeeding have been found to increase the rates of initiation, duration, and exclusivity of breastfeeding. Consider multiple strategies, including: > · Formal breastfeeding education for mothers and families > · Direct support of mothers during breastfeeding > · Training of primary care staff about breastfeeding and techniques for breastfeeding support > · Peer support > Interventions that include both prenatal and postnatal components may be most effective at increasing breastfeeding duration. > In rare circumstances, for example for mothers with HIV and infants with galactosemia, breastfeeding is not recommended. Interventions to promote breastfeeding should empower individuals to make informed choices supported by the best available evidence. > > If any of you are willing and able a concise letter regarding the problems you have in providing care due to finanacial barriers for mother, this would be extremely helpful to the work of USLCA Licensure and Reimbursement Committee. We would use it as evidence in legislative hearings regarding licensure and documentation of problems for insurers. We are in talks with Medicaid administrators and also beginning to reach out to Medicaid Directors at the state level about this issue. Medicaid will not pay for the services of IBCLCs are present because we are not licensed providers. > > At this time, you could also send a letter in support of the IOM policy recommendation which is pending approval to : > The Honorable Kathleen Sebelius > Secretary , US Department of Health and Human Services > 200 Independence Ave, SW > Washington DC 20201 > Please be aware that mail sent to our Washington D.C area offices takes an additional 3-4 days to process Or > Toll Free: 1- > Or Complete an online form at this link. > > Also, I would like permission to forward this message with you quotes, , Dee and to some other IBCLC listserv to make the same request. It would go to only listserv’s that have limited membership, USLCA Licensure and, Reimbursement committee, PA LCLicensure, > > > Judy > Judith L. Gutowski, BA, IBCLC, RLC > 135 McGrath Lane > P Box 1 > Hannastown, PA 15635-0001 > Cell Phone > Fax > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2011 Report Share Posted August 2, 2011 So many replies are close to what my own would be. I too have to find a balance between helping others and not hurting myself. And it is not about not being a good business woman, for me, it is about what I am comfortable with. I do the same in other aspects of my life also. If someone is truly in need, I will give what I can. I don't think it is a bad thing really. In the long run, it has earned me several clients those same mommas referred to me, so it does work out okay really. I do go through all the options, but sometimes they already tried everything else...and they are hoping I can do something different. For those who are truly in need, they have to come to me. I do not do freebie or low fee home visits. Just don't. The drive to me is their investment. And, they have to pay something. What I ask them to do is place an amount they can afford in an envelope and seal it, leave it at the entry table, and I will open it when they leave. I am comfortable with this and I agree mothers feel much better when they pay for their care. I won't say that I have not been taken advantage of, I have been. But, that's okay. I did not leave my kids, I did not spend money on gas, and who am I to say that she could afford me because she can afford to drive a Mercedes or a Lexxus. I live in an expensive house, in an expensive neighborhood...and trust me, I could not afford me! I have taken payments, I have taken post dated checks, and I have even bartered. Sometimes, I go see a mom and she is paying full fee, and I can see that my full fee is going to be a hardship, even though she never says a thing. I will usually take a few dollars off and tell her the drive was not as long as I expected, or the situation is not as difficult, or something, or sometimes just offer her a free follow up at my home when I would charge someone else. Then, this mom's pediatrician refers more to me because he heard good things from the mom I helped. And, sometimes, that same mom has me come to her with her next baby and pays the full fee....it really does all come around and balance out. Pam MazzellaDiBosco, IBCLC, RLCBirthing & Beyond, Inc.Labor Support and Lactation Consultant Services Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2011 Report Share Posted August 2, 2011 I do the same thing, Pam (giving moms a discount if necessary when I show up and see the situation). Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comBreastfeeding Between the Lines: http://second9months.wordpress.com/--- From: Pam MazzellaDiBosco Subject: Re: What do you think?To: Date: Monday, August 1, 2011, 6:20 PM So many replies are close to what my own would be. I too have to find a balance between helping others and not hurting myself. And it is not about not being a good business woman, for me, it is about what I am comfortable with. I do the same in other aspects of my life also. If someone is truly in need, I will give what I can. I don't think it is a bad thing really. In the long run, it has earned me several clients those same mommas referred to me, so it does work out okay really. I do go through all the options, but sometimes they already tried everything else...and they are hoping I can do something different. For those who are truly in need, they have to come to me. I do not do freebie or low fee home visits. Just don't. The drive to me is their investment. And, they have to pay something. What I ask them to do is place an amount they can afford in an envelope and seal it, leave it at the entry table, and I will open it when they leave. I am comfortable with this and I agree mothers feel much better when they pay for their care. I won't say that I have not been taken advantage of, I have been. But, that's okay. I did not leave my kids, I did not spend money on gas, and who am I to say that she could afford me because she can afford to drive a Mercedes or a Lexxus. I live in an expensive house, in an expensive neighborhood...and trust me, I could not afford me! I have taken payments, I have taken post dated checks, and I have even bartered. Sometimes, I go see a mom and she is paying full fee, and I can see that my full fee is going to be a hardship, even though she never says a thing. I will usually take a few dollars off and tell her the drive was not as long as I expected, or the situation is not as difficult, or something, or sometimes just offer her a free follow up at my home when I would charge someone else. Then, this mom's pediatrician refers more to me because he heard good things from the mom I helped. And, sometimes, that same mom has me come to her with her next baby and pays the full fee....it really does all come around and balance out. Pam MazzellaDiBosco, IBCLC, RLCBirthing & Beyond, Inc.Labor Support and Lactation Consultant Services Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2011 Report Share Posted August 2, 2011 To all of you who would not accept insurance for your work, are you opposed to other IBCLCs receiving insurance reimbursement? I couldn't get a sense of that as I read your responses. I happen to work at a clinic where we accept insurance for all IBCLC services (cost is one co-pay for Mom, one co-pay for baby) and I have absolutely no doubt that this allows me to see far more women and thus support breastfeeding more broadly in the community. Moms with Medical Assistance have no co-pays. I love being able to support breastfeeding Moms in this environment. And the Moms who we see are THRILLED (and still breastfeeding!). Ellen Ellen Rubin, MA, IBCLC, LLLL Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2011 Report Share Posted August 2, 2011 Oh I am totlly fine with LCs taking insurance. I would even refer moms to them if they needed it. I also am all for moms being reimbursed. I just can't afford to work for less and hope for volume. I don't want to work in a clinic setting. I prefer home visits and I don't work on a salary. Like I said working on a back up plan and I no longer see myself doing this for the rest of working years. It was great but if the future is more work for less money I won't be able to do it and feed my family. For some it may help for others it may hurt and in the long run I see LCs being more controlled by the insurance industry model of care. If the docs and other well established health care providers with all their clout can't get the industry to keep the pay in line with their fees how do measly LCs expect to? I know the intention but I have little faith that the industry will meet the expectations. I do believe mothers and babies deserve equal access to care but I also know even those with insurance do not get equal care in other aspects of health. Insurance companies determine access and quality. I don't have any solutions. The problem is a systemic disease of our healthcare system which has many symptoms and it seems no cure in sight. Pam MazzellaDiBosco, IBCLC Pam MazzellaDiBosco. IBCLC Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2011 Report Share Posted August 2, 2011 I am guessing that insurance is in no way covering the costs and you would never be able to be paid and manage your overheard if you had to accept only what they pay. My guess is also that insurance coverage will make it less and less possible for PP LCs to practice and only clinic or other offices could manage this. I also imagine the quality of care will diminish just as it has in all areas of medicine within our disease-care model. Opposed? No, I don't have the energy to oppose what others choose to do. I think it's short-sighted and do the same that having LCs in hospitals has done--increase initiation, decrease duration. I am not hopeful that going down the same path that has mismanaged every other kind of care is going to improve this one. Tow, IBCLC, France > > To all of you who would not accept insurance for your work, are you opposed to other IBCLCs receiving insurance reimbursement? I couldn't get a sense of that as I read your responses. > > I happen to work at a clinic where we accept insurance for all IBCLC services (cost is one co-pay for Mom, one co-pay for baby) and I have absolutely no doubt that this allows me to see far more women and thus support breastfeeding more broadly in the community. Moms with Medical Assistance have no co-pays. I love being able to support breastfeeding Moms in this environment. And the Moms who we see are THRILLED (and still breastfeeding!). > > Ellen > > Ellen Rubin, MA, IBCLC, LLLL > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2011 Report Share Posted August 2, 2011 Hi Judy, It sounds like you might not need it anymore, but just in case, please feel free to use any or all of my post. Warmly, Carroll > > > > Also, I would like permission to forward this message with you quotes, > , Dee and to some other IBCLC listserv to make the same request. > It would go to only listserv's that have limited membership, USLCA Licensure > and, Reimbursement committee, PA LCLicensure, > > > > > > Judy > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2011 Report Share Posted August 2, 2011 Thank you so, so much to all of you who have given me suggestions or made comments regarding my post. You have given me a lot of food for thought and the additional discussions around reimbursement have been very interesting. As I read through the posts, I felt very reassured about just how far I have gone to help this mom. I think I am going to check with her about bartering. She is very computer savvy and could help me with some stuff in that area if she is willing. Thanks again! Carroll Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 3, 2011 Report Share Posted August 3, 2011 Somehow, Judy, I did not see the paragraph asking for permission to share quotes. Yes, you have my permission. Dee Kassing Hi Judy,It sounds like you might not need it anymore, but just in case, please feel free to use any or all of my post.Warmly, Carroll> > Also, I would like permission to forward this message with you quotes,> , Dee and to some other IBCLC listserv to make the same request.> It would go to only listserv's that have limited membership, USLCA Licensure> and, Reimbursement committee, PA LCLicensure, > Judy> > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 3, 2011 Report Share Posted August 3, 2011 We have had the similar conversation in another group. This is my views in the subject matter;Insurance based health care is *usually* requires a much higher volume and less detailed care. 2 years ago BCBS offered me $18.00 an hour reimbursement in return I would be classify as an PP. For that I have to have a setting like an open dentist surgery. Chairs in a semicircle, breast out, hold the baby, watch the mouth and let the baby latch... It is like a black comedy.It is for the same reason many of the *good* HCP, holistic practicioners in my area -including our Ped for the last 10 years isn't bothering with the insurance. Just like me they do give out the ICD codes and let the patient deal with submitting, reimbursement, endless phone calls, etc. I am spending enough time as it is filling out paperwork, I can happily opt-out on this.I know it is a shame for a mom who may not be able to reach to an LC any other-way (I am saying this, but I am pretty sure that we all have either some free or sliding scale for these moms). Like I see all the WIC moms referred to me by my local WIC office free of charge, as well as I put this on my website for all to see. The sad thing is most of the time these are the families gives me a check when its time for me to leave vs the posh moms.Another important thing is to knowing your work load, what works for you and your situation. I set-up my PP as a business where I earn money. I do not work for a clinic, or Dr's office. This was my *business* choice, and I am -and my bank balance- is much happier since I have made this distinction (I have been an LLLL for 10 years which made very difficult for me to switch hats and the way I think about PP) Kindly,Ann who is looking forward to healthcare system run by the HCPs not insurance companies with in the US.Ann Faust, MBChB, BA (Hons), IBCLC, RLC BABY AND ME LACTATION SERVICES LLC www.BabyAndMeLC.com Facebook: Baby And Me Lactation Services phone: This information is for general informational purposes only and is not intended to provide specific authority, advice or recommendations. Where you deem necessary, we suggest that you seek advice regarding your particular situation from the appropriate professional. The information contained in this e-mail may be confidential and is intended solely for the use of the named addressee. Access, copying or re-use of the e-mail or any information contained therein by any other person is not authorized. If you are not the intended recipient please notify us immediately by returning the e-mail to the originator. This e-mail transmission and any documents, files or previous e-mail messages attached to it, are confidential. If you are not the intended recipient, or a person responsible for delivering it to the intended recipient, you are hereby notified that any review, disclosure, copying, dissemination, distribution or use of any of the information contained in, or attached to this e-mail transmission is STRICTLY PROHIBITED. If you have received this transmission in error, please immediately notify Baby and Me Lactation Services, LLC by telephone at (240)893-3808 and then delete the message and its attachments from your computer. Thank you. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 3, 2011 Report Share Posted August 3, 2011 yeah, that really is the downside of working in the united states for me. having workeed in other countries, then coming here it was laughable and sad to me that our healthcare system is run by insurance companies and not clients/patients and health care providers. To me the solution is very obvious. Have a healthcare system like that of other countries. The reason however that it works so well in other countries is that they're smaller. So top-down healthcare from the bottom up -works especially well when there's not a big gap between the top and the bottom, as there is in the USA. Perhaps each state (or group of states if they are smaller states) should do top down affordable health care solutions. On thing I loved about almost every other country I've been in the developed world is that the concept of insurance was foreign. Insurance companies are a business. They tell lies to everyone and people continue to believe them. o.t.o.h. that's what's we've got at the moment so it's going to be tough to phase out of having them around -if it even ever happens. > > We have had the similar conversation in another group. This is my views > in the subject matter; > > Insurance based health care is *usually* requires a much higher volume > and less detailed care. 2 years ago BCBS offered me $18.00 an hour > reimbursement in return I would be classify as an PP. For that I have > to have a setting like an open dentist surgery. Chairs in a > semicircle, breast out, hold the baby, watch the mouth and let the baby > latch... It is like a black comedy. > > It is for the same reason many of the *good* HCP, holistic > practicioners in my area -including our Ped for the last 10 years isn't > bothering with the insurance. Just like me they do give out the ICD > codes and let the patient deal with submitting, reimbursement, endless > phone calls, etc. I am spending enough time as it is filling out > paperwork, I can happily opt-out on this. > > I know it is a shame for a mom who may not be able to reach to an LC > any other-way (I am saying this, but I am pretty sure that we all have > either some free or sliding scale for these moms). Like I see all the > WIC moms referred to me by my local WIC office free of charge, as well > as I put this on my website for all to see. The sad thing is most of > the time these are the families gives me a check when its time for me to > leave vs the posh moms. > > Another important thing is to knowing your work load, what works for you > and your situation. I set-up my PP as a business where I earn money. I > do not work for a clinic, or Dr's office. This was my *business* choice, > and I am -and my bank balance- is much happier since I have made this > distinction (I have been an LLLL for 10 years which made very difficult > for me to switch hats and the way I think about PP) > > > Kindly, > Ann who is looking forward to healthcare system run by the HCPs not > insurance companies with in the US. > > > Ann Faust, MBChB, BA (Hons), IBCLC, RLC > > BABY AND ME LACTATION SERVICES LLC > www.BabyAndMeLC.com <http://www.babyandmelc.com/> > Facebook: Baby And Me Lactation Services > phone: > > > > > This information is for general informational purposes only and is not > intended to provide specific authority, advice or recommendations. Where > you deem necessary, we suggest that you seek advice regarding your > particular situation from the appropriate professional. > > > The information contained in this e-mail may be confidential and is > intended solely for the use of the named addressee. Access, copying or > re-use of the e-mail or any information contained therein by any other > person is not authorized. If you are not the intended recipient please > notify us immediately by returning the e-mail to the originator. > This e-mail transmission and any documents, files or previous e-mail > messages attached to it, are confidential. If you are not the intended > recipient, or a person responsible for delivering it to the intended > recipient, you are hereby notified that any review, disclosure, copying, > dissemination, distribution or use of any of the information contained > in, or attached to this e-mail transmission is STRICTLY PROHIBITED. If > you have received this transmission in error, please immediately notify > Baby and Me Lactation Services, LLC by telephone at (240)893-3808 and > then delete the message and its attachments from your computer. Thank > you. > Quote Link to comment Share on other sites More sharing options...
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