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Breastfeeding and Obamacare - Page 2

post #21 of 74

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. :stillheart 

post #22 of 74

I would suggest taking a look at the Netherlands and copying their model.  They are supportive in pregnancy, natural birth, maternity and paternity leave, and breastfeeding, as well as childcare and schooling.

post #23 of 74
Quote:
Originally Posted by EliteGoddess View Post
 

I would suggest taking a look at the Netherlands and copying their model.  They are supportive in pregnancy, natural birth, maternity and paternity leave, and breastfeeding, as well as childcare and schooling.

I wish the USA would! Sadly, so many are so afraid of "Socialism" that any hint of this type as wonderful type of care is shot down by too many before it even gets a change to be looked at in detail.

 

I'd be 100% behind such a system. :)

post #24 of 74

I'd also be in favor of such a system (and I"m pretty much a  libertarian, too), though I do get wary at those who insist on mandatory paid maternity leave paid for completely by a business owner without considering this would be detrimental to many, many small businesses. 

 

As it stands, I understand that many countries that require paid maternity leave only require 50% of the paycheck.

post #25 of 74
Thread Starter 

MaggieLC - Great post! There is a very good reason why you are frustrated. To help explain that reason, here's a quote from a July 18, 2013 press release from the U.S. Breastfeeding Committee: the first sentence reads, "In the rapidly-changing landscape of insurance requirements rolling out under the Affordable Care Act, few have been more confusing than the requirement to cover "breastfeeding support, supplies, and counseling" (starting in the first plan year that began on or after August 1, 2012)."

 

Here are the guidelines for insurance companies that were issued by the U.S. Department of Health and Human Services: "Comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum period, and costs for renting breastfeeding equipment." That's it. There are no further instructions for insurance companies to follow. No standards. No definitions. No recommendations. Every time I read those "guidelines" I come up with another question or two... and  there's no method to get answers to my questions.

 

As far as I'm concerned, the "guidelines" issued by the DHHS are not guidelines at all. What they issued merely represents the goal that is trying to be accomplished. The instructions or rules that are needed in order to achieve that goal are totally missing. If you have any questions or complaints about your insurance coverage for breastfeeding support and services, please contact your Congressperson or Senator... they're the ones who created this mess!

post #26 of 74

What you need is longer paid maternity leave. That is what undermines breastfeeding the most, I think--having to go back to work at 4 or 6 weeks or whatever. Most countries get something like 6 months, a year, ect.

post #27 of 74
Quote:
Originally Posted by MichelleZB View Post
 

What you need is longer paid maternity leave. That is what undermines breastfeeding the most, I think--having to go back to work at 4 or 6 weeks or whatever. Most countries get something like 6 months, a year, ect.

 

I still don't think this can be addressed at all under the Healthcare mandate.  It concerns insurance companies and their policies.  What this would take is another law (laws!) entirely, mandating businesses to pay for the extended leave, providing the funds for small businesses that can't afford to pay for leave plus a replacement employee, or creating a fund employees pay into.

 

Not Obamacare's territory at all.

post #28 of 74
Quote:
Originally Posted by devoted2kids View Post
 

MaggieLC - Great post! There is a very good reason why you are frustrated. To help explain that reason, here's a quote from a July 18, 2013 press release from the U.S. Breastfeeding Committee: the first sentence reads, "In the rapidly-changing landscape of insurance requirements rolling out under the Affordable Care Act, few have been more confusing than the requirement to cover "breastfeeding support, supplies, and counseling" (starting in the first plan year that began on or after August 1, 2012)."

 

Here are the guidelines for insurance companies that were issued by the U.S. Department of Health and Human Services: "Comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum period, and costs for renting breastfeeding equipment." That's it. There are no further instructions for insurance companies to follow. No standards. No definitions. No recommendations. Every time I read those "guidelines" I come up with another question or two... and  there's no method to get answers to my questions.

 

As far as I'm concerned, the "guidelines" issued by the DHHS are not guidelines at all. What they issued merely represents the goal that is trying to be accomplished. The instructions or rules that are needed in order to achieve that goal are totally missing. If you have any questions or complaints about your insurance coverage for breastfeeding support and services, please contact your Congressperson or Senator... they're the ones who created this mess!

Thank you.

 

Yes, the "guidelines" are so vague that it allows insurance companies to interpret them as they want. Nothing about breastfeeding "supplies" that need to be bought rather than rented (nipple shields, SNSs, tubing, syringes, shells) or pumps that are for purchase only. "Trained provider" could be ANYTHING. They need to identity "Board Certified Lactation Consultant who has completed the paths and passed the Boards laid out by the International Board of Lactation Consultant Examiners." Nope, "trained professional" which leaves the door open for people who have taken a weekend intensive intended for teaching classes to evaluate and set up treatment plans that they are not trained or educated to do.

 

I don't do any billing. (Thank heavens, I work for an agency that does all that. When I had my own business I did, but that was several years ago. I'm glad to be part of an agency that does all the billing and insurance stuff for us.) Basically, we have to let the clients submit their own bills as we have been doing. It is frustrating for us and the clients.

post #29 of 74

What if the insurance companies offered some incentives to the doctors who encourage breastfeeding and maintained high breastfeeding rates among moms with babies?  Doctors should also be required to get enough training to be lactation consultants. I really do think it would make a difference if people got this information from their personal doctors vs. having to seek out a LC or someone else.  It makes it seem less important, kwim?  If women are hearing that breast is best from people they know, but formula is just fine from their doctor, who are they going to trust?

 

Just imagine if DOCTORS put the same emphasis and effort on breastfeeding as they do for vaccines?  

post #30 of 74

I would like to respectfully disagree with the whole idea of getting more laws about breastfeeding on the books.  Breasfeeding is important but it is best supported and encouraged locally, by family members and friends and random strangers smiling at other random strangers who breastfeed in public.  Getting a government agency involved is only going to add red tape to the process.  

 

The fact is, the la leche league is free.  As is internet access with the multitude of research and resources that are on here.  New moms don't need the government to tell them to do one more thing (in that cute formula bag are more papers than I've had to read since college).  New moms need their communities to reach out and help them see that breastfeeding is healthy AND normal.  Post a flyer for a la leche meeting on a library bulletin board.  Talk to other new moms about breastfeeding's benefits.  That will do more than paying a government worker to pay an insurance company to pay someone to keep track of what breastfeeding support options are so that the whole system can then pay for lactation consultants that many new moms don't want. 

 

Breastfeeding or lack thereof is a cultural issue and I think we need to attack it that way.  Formula is not normal!   Spread the word! :) :) :) :)

post #31 of 74
Quote:
Originally Posted by fayebond View Post

I would like to respectfully disagree with the whole idea of getting more laws about breastfeeding on the books.  Breasfeeding is important but it is best supported and encouraged locally, by family members and friends and random strangers smiling at other random strangers who breastfeed in public.  Getting a government agency involved is only going to add red tape to the process.  

The fact is, the la leche league is free.  As is internet access with the multitude of research and resources that are on here.  New moms don't need the government to tell them to do one more thing (in that cute formula bag are more papers than I've had to read since college).  New moms need their communities to reach out and help them see that breastfeeding is healthy AND normal.  Post a flyer for a la leche meeting on a library bulletin board.  Talk to other new moms about breastfeeding's benefits.  That will do more than paying a government worker to pay an insurance company to pay someone to keep track of what breastfeeding support options are so that the whole system can then pay for lactation consultants that many new moms don't want. 

Breastfeeding or lack thereof is a cultural issue and I think we need to attack it that way.  Formula is not normal!   Spread the word! smile.gifsmile.gifsmile.gifsmile.gif

I understand what you are saying, but the point of this is Lactation consultants are health care providers who deserve to be paid for thier work. I'm s LLL leader AND an IBCLC and there are mamy things IBCLCs know and can evaluate and set up treatments that are not on a LLL leader's Scope of Practice.

The AHCA isn't covering Profesional Lactation consultants on enough detail so that we can serve the needs of our clients properly so we can also be reimbursed for our expertise and our time.
Edited by MaggieLC - 10/4/13 at 4:55pm
post #32 of 74

There is a lot government policy can do to help, though.

 

For instance, that "formula bag" you mentioned? In Canada, I didn't get one. It's not policy to give them out. Formula is available in the hospital for those who need it and no more. Also, all supplemented newborns in the hospital can be cup fed instead of bottle fed, which can help with latch. My hospital had that policy also.

 

The WHO has something called the "Baby Friendly Hospital Initiative" which is a bunch of policies for hospitals to adopt to be breastfeeding friendly. Governments can supply funding and training to hospitals and require they adopt the policy.

post #33 of 74
Quote:
Originally Posted by heldt123 View Post
 

What if the insurance companies offered some incentives to the doctors who encourage breastfeeding and maintained high breastfeeding rates among moms with babies?  Doctors should also be required to get enough training to be lactation consultants. I really do think it would make a difference if people got this information from their personal doctors vs. having to seek out a LC or someone else.  It makes it seem less important, kwim?  If women are hearing that breast is best from people they know, but formula is just fine from their doctor, who are they going to trust?

 

Just imagine if DOCTORS put the same emphasis and effort on breastfeeding as they do for vaccines?  

I know a lot of people think this, BUT, it takes three years of post graduate work to become a Board Certified Lactation Consultant plus sitting for 8 hour Board Examinations every 5 to 10 years and 75 hours of continuing education credits in Lactation every 5 years! That would make Med School 7 years long, plus an other Board, and it just isn't feasible. Some doctors do become IBCLCs, but it isn't within the reach of most. It's a LONG difficult program! It's a Master's Certification Program and that just isn't going to fly with most doctors, who do need to get working in less than, say 12 years after they start Med School, which it would take IF they were all IBCLCs.

 

What needs to happen is that physicians need to know WHERE AND WHEN their Scope of Practice ends and WHEN and WHOM TO refer to!  If every MD who runs into a Lactation issue knows to refer to an IBCLC and knows the LCs in his or her area and is willing to refer instead of just guessing how to solve a problem he knows nothing about all patients would be served better. Some doctors do, they may have IBCLCs on staff, they may have working relationships with agencies like the one I work for and they may know and refer to Private Practice IBCLCs in their area. That is going to be a more workable solution than expecting every MD in the USA to earn a IBCLC that would take him or her an additional 3- 5 years of their lives. They don't need to know everything about breastfeeding, they just need to know when and whom to refer the issues to.

 

The IBLCE (International Board of Lactation Consultant Examiners) web page is down for updates, but this site has an overview of what is required to even sit for Boards. http://www.wikihow.com/Become-a-Lactation-Consultant

 

In the 20+ years I have been practicing, I have only known one IBCLC who did not have either a Bachelor's Degree or a Registered Nursing Degree before sitting for her boards, obtaining her patient contact hours, getting her 90 Education Hours etc. This woman was a truly amazing woman (who had been in nursing school when she became pregnant with her first child and had to drop out) who did much for the cause of Lactation. However, she, at the time, needed to obtain 1,000 hours of Clinical Practice (patient contact hours) and also take college level Biology, Chemistry, Medical Terminology, Anatomy and Physiology, Child Development, Fetal Development and more, as one would when one majors in a medically related or nursing field in college.)  What I'm saying is Lactation Consulting is ONE career, Medical Practice is an OTHER career, there are people who do both, but as both are time consuming in both educational preparation and sustaining the credentials of each, few people can do both. Lactation Consulting isn't something someone just decides to do one day and starts doing it a few weeks or months later, It's an entire career that takes years of education, planning and training.

 

I don't think "requiring" MDs to all become IBCLCs is going to work, nor will it ever be implemented. Plus, then what are those of us that have dedicated our lives to Lactation completely and are NOT doctors going to do? :)


Edited by MaggieLC - 10/4/13 at 6:20pm
post #34 of 74

fayebond, I just wanted to add one thing. You said: " That will do more than paying a government worker to pay an insurance company to pay someone to keep track of what breastfeeding support options are so that the whole system can then pay for lactation consultants that many new moms don't want. "

 

There isn't a "government worker" who is doing this or who are going to be doing this. This isn't part of anybody's plan.

 

What is needed is for insurance companies and Medicaid to be willing to pay Board Certified Lactation Consultants, as they pay MDs and other health care workers if and when mothers need a Lactation Consultant's help.

 

I can assure you that if all women got at least a preliminary IBCLC visit within the first week or two after the baby's birth, we'd have a much higher breastfeeding success rate and more women would breastfeed and infant and child health would improve in this country.

 

I can also assure you that few, if any new moms don't either need some help or would like a consultation to make sure everything is going well. If I had an extra dollar for every woman who has said to me, "I wish I had called you earlier." Or "I wish I had called you with my first baby. I gave up after a week because I was getting so much conflicting information from so many people and couldn't make it work!" I'd be a rich IBCLC. (I'm not rich, BTW. ;) )

 

I just wanted to add that "a smiling stranger" or most "family members" aren't going to be able to diagnose, refer and set up a treatment plan for a baby with a submucosal Ankyloglossia (tongue tie) or a mom with Clinical Ductal Insufficiency, or many other situations where a professional is needed. Yes, it's nice when people smile, and community support is neeeded but part of the problem is that so many women are getting bombarded with SO much improper and/ or outdated information that often breastfeeding becomes nearly impossible as one "opinion" after an other comes in.

 

For a new mom to consult with one of us and be able to say to those "smiling strangers" and "family members" who are telling the mom 1000 different things at once, "My Lactation Consultant and I have a strategy plan in place. Her information is a little different than what you are telling me to do. I'll decide what to do about this myself based on the information I got during my consultation." is a relief from the bombardment of often unwanted and erroneous information so many new mothers are subjected to. And LLL is a great organization and helps millions of women, but some situations are more complicated than what can be handled by a volunteer. I've worked at LLL headquarters as a counselor, I've been a LLL leader and I'm an IBCLC, so I am aware there are major differences in what each can do.


Edited by MaggieLC - 10/4/13 at 6:14pm
post #35 of 74

Not to be argumentative here- but I don't think anyone has suggested what is obvious at least to me.  Quit giving out formula via WIC.  Give a pump and call it a day.  Should there be the rare but real case of NOT being able to BF- then have the dr write an rx for formula or the parent can purchase the formula.  This is not rocket science and more mandates and laws and whatnot are not the answer.  You want healthier babies and moms?   Quit giving them the crap that makes them unhealthy.

post #36 of 74
Quote:
Originally Posted by iowaorganic View Post

Not to be argumentative here- but I don't think anyone has suggested what is obvious at least to me.  Quit giving out formula via WIC.  Give a pump and call it a day.  Should there be the rare but real case of NOT being able to BF- then have the dr write an rx for formula or the parent can purchase the formula.  This is not rocket science and more mandates and laws and whatnot are not the answer.  You want healthier babies and moms?   Quit giving them the crap that makes them unhealthy.

And I ask why should the government be able to decide how moms who are struggling financially feed their children.
post #37 of 74
I think I mentioned it earlier. That is how it already is in my Canadian hospital. You don't get formula samples routinely. It does help breast feeding rates.

TCMoulton is being very alarmist. Poor moms are responsible for feeing their children for eighteen years, whether they get a free can of formula or not. Avoiding advertising formula to poor mothers is not screwing them over. With breast freeding well established, I fed my baby for free for six months, saving scads of money.

Besides, the nurses in our hospital had cans of formula on hand just in case. Moms in need could say, "oh, hey, I'm planning on formula feeding. Do you have any samples you can throw me?" And the nurses would just give them a can or two from the cupboard.
post #38 of 74
Quote:
Originally Posted by iowaorganic View Post
 

Not to be argumentative here- but I don't think anyone has suggested what is obvious at least to me.  Quit giving out formula via WIC.  Give a pump and call it a day.  Should there be the rare but real case of NOT being able to BF- then have the dr write an rx for formula or the parent can purchase the formula.  This is not rocket science and more mandates and laws and whatnot are not the answer.  You want healthier babies and moms?   Quit giving them the crap that makes them unhealthy.

 

This is incredibly judgmental. There are so many moms who have no family support for breastfeeding, no partner, have to go back to work asap and don't feel that they can adequately pump and work. The idea that every mom can breastfeed is great, but honestly it's not feasible for some people. The idea that you can "choose" to stay at home after your baby is born or the idea that you can "stand up for your right to pump at work" is great for those of us in upper class, middle class, and lower middle class existances. Most people on wic aren't in those shoes, and the idea that they should just be given a pump and expected to "deal" is absurd if they came from a family of formula feeding people, have to work 40+ hours a week on minimum wage just to cover the bills, have no support, and are already in a really hard situation.

 

The fact is that just because you have chosen to be really dedicated to something, doesnt mean that the government should choose how other people's babies get fed.

 

As far as the evils of formula go, do you have any idea what people would be feeding their kids if they didn't have access to infant formula? Take a look back in history, you'll see what babies are fed when they dont breastfeed but have no access to formula. 

post #39 of 74
Not routinely advertising to moms is not the same as forbidding them from formula feeding. People on this thread are making it seem like adopting a baby-friendly hospital policy is like the government FORCING you to breastfeed. It's so ridiculous that it's hard to believe what I'm reading.

Also, the way some people talk, it sounds like hospitals give out like 12 months worth of formula per mom. Don't they just give out a can or two, get people hooked on a brand, then they're on their own?
post #40 of 74
Thread Starter 

The employees at hospitals give free formula to new moms because the hospital gets a break from the formula manufacturer on the price it pays for formula. Some people would call that a kickback. When a first time mom receives free formula from a health care professional on the way out of the hospital it sends the message that formula feeding must be the best method of feeding the baby. There are also some social and cultural issues at play here. Many of the young moms on WIC live in households where formula feeding has been the norm for a generation or two. Those moms don't have people encouraging them to breastfeed.

 

As far as WIC is concerned, the funding for the WIC breastfeeding peer counselor program (which was very successful) has been drastically reduced. The same is true for the WIC tv ad campaign which promoted breastfeeding (which was also another successful program). I suspect the lobbyists for the formula companies were behind those changes. Fewer breastfeeding moms = more formula sales.

 

Another issue to consider here is that a large percentage of WIC moms are covered by Medicaid. The U.S. Secretary of Health and Human Services was given the task of writing the regulations that insurance companies would follow in order to fulfill the requirement by Congress that the insurance companies promote and support breastfeeding as part of the Affordable Care Act. The Secretary of DHHS turned to the Institute of Medicine for advice on how to best achieve that goal. In the IOM study "Clinical Preventive Services for Women" the IOM wrote this "In an analysis of state Medicaid provisions, the Henry J. Kaiser Family foundation found that 25 states cover breastfeeding education services, 15 states cover individual lactation consultants, and 31 states cover equipment rentals, such as breast pumps." Even though the IOM knew how inconsistent health care coverage was under Medicaid, this was their recommendation to the Secretary of DHHS regarding the guidelines for insurers to promote and support breastfeeding in the Affordable Care Act: "The committee recommends for consideration as a preventive service for women: 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."

 

As noted in early posts, that language is woefully inadequate. It doesn't state what qualifications a "trained provider" must have. It doesn't say who will decide what kind of breast pump is provided. It doesn't offer a definition of "comprehensive lactation support and counseling." Even some insurance companies who used to provide good quality breast pumps have now switched to cheaper inappropriate breast pumps because the regulations are so lax. By the way, the U.S. Secretary of DHHS is Kathleen Sebelius.

 

One more thing, the Institute of Medicine wrote the following in the introduction to the report noted above: "Given the magnitude of change, the U.S. Department of Health and Human Services charged the Institute of Medicine with reviewing what preventive services are important to women's health and well-being and then recommending which of these should be considered in the development of comprehensive guidelines." The IOM committee came up far short of what was expected of them. Their recommendation has done little or nothing to "promote and support" breastfeeding!

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