As a working Board Certified Lactation Consultant (even though I am in favor of about 95% of the Affordable Health Care Act) we, as IBCLCs have been having problems with the new rules in the AHCA ("Obamacare.") Some of the insurance companies assume that new mothers ONLY need Lactation Consultants while they are "in the hospital" and thus are only wanting to compensate what they are terming "Certified Nurse Specialists." Um, many Lactation Consultants are not "Certified Nurse Specialists" and most breastfeeding issues occur 5-25 days after the birth of the baby and NOT while mom and baby are "still in the hospital." This thinking also disregards that some women never give birth in a hospital, or leave within hours of giving birth, so seeing a "Certified Nurse Specialist" (who do NOT work as Private Practitioner) at all.
Also, IBCLCs are International Board Certified meaning we are NOT "state certified" or "licensed" at all. We are Internationally Certified (which means we can practice anywhere in the world or in any state in the USA without further certification) and are registered but, for some reasoned are not "licensed."
A few weeks ago we had a client who specified she needed a "Certified Nurse Specialist" because that is what her insurance company (knowing NOTHING about lactation) required in order to reimburse her) and when we told her that wasn't what we were, she started calling all the "Certified Nurse Specialists" in her area. ALL of them were hospital based, NONE were Private Practice (which meant that NONE of them would see patients in their homes) and NONE of them were "specialists" in Lactation. She got some surgical CNS, addiction CNS, respiratory care CNS but NONE of them were Lactation Consultants nor would see a patient who wasn't an inpatient in a hospital or in hospice. As a result she was told that she had to pay out of pocket, and we did recommend she see one of our LCs and then submit the SuperBill after the visit, knowing they might not pay her back.
We're terrified that more and more clients will run into this misunderstanding by insurance companies of WHAT IBCLCs are, what we do, and where we work (most of us do NOT work in hospitals, and the ones who do work in hospitals will not come to make a home visit making women with newborn babies have to go out of her own comfortable home for a short visit. (My visits, as a Private Practice IBCLC working for a labor and post partum doula-midwife-lactation agency, usually run 90 to 120 minutes and take place in the clients home. The average LC visit in a hospital run about 3-10 minutes.)
As for "free lactation care" I'm not sure how we can get insurance companies to pay for visits. We need to make a living, too, and so our agency charges at the time of service (through the agency I don't take any money, thank heavens. I did that as a home based Private Practice LC and it was not pleasant) we fill out the Super Bill and then fax it to the client for her to submit to the insurance company. If there was an easier way to do this and still get paid for our services and not burden our clients unduly, I can't think of one.
The insurance companies and The Affordable Care Act need to understand 1) ONLY IBCLCs should be seeing lactation clients for lactation problems professionally, (no "lactation nurses" with no training and no "certified lactation educators." These people are only certified to teach breastfeeding classes. NOT to examine mothers and infants or diagnose lactation issues, set up treatment plans or assist with feeding in any way. They have a weekend intensive for training, as IBCLCs we learn and train for THREE years, as a post graduate program after earning at least a Bachelor's Degree in a related field, and then sit for 8 hour boards... every 5 to 10 years for the entire time we practice, as well as keep up CERPs for continuing education. The gap between "Certified Lactation Educators" and "Board Certified Lactation Consultants" is about as wide as the gap between someone who took a High School level First Aid Class and an MD with 4 years of Med School and years of residency plus sitting for their boards. (If I sound upset, I am. You can't bill yourself as anything that sound like a physician, if you aren't a physician, yet there several groups of minimally trained people who bill themselves as "Lactation Consultants" or "Lactation Specialists" and the law is dong NOTHING about these people misrepresenting themselves and mothers and babies are not being served and in many cases even hurt by these misunderstandings. Of course, this leaves La Leche League Leaders in Limbo as many of them are very well educated in lactation but many lack certification. But, as LL leaders do not and MAY Not charge for their services, it is a different thing.)
2)(yes, there is more) The AHCA and the insurance companies need to understand that many IBCLCs are not RNs and do not need to be. All IBCLCs are specialists in LACTATION only and need to sit for the same boards, get their CERPs, their classes, their Patient Contact Hours the same as any other IBCLC. (Not to mention there is a NEW "thing" called a "Advanced Lactation Consultant" that can be had without first becoming a Board Certified IBCLC! It's the Wild West out here in Lactation, ladies.)
3) IBCLCs do not all work in hospitals and most lactation issues happen after release from the hospital after the baby's birth AND some women do not even give birth in hospitals, but they need lactation services as well.
Sorry for the text wall. I had to speak my piece. This is my livelihood and this is my passion.